| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |
Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 sq in but less than or equal to 48 sq in
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |