Modular multilevel converters (MMC) inherent features are gaining more attention for dc voltage transmission systems. One of the main research paths regarding the converter performance deals with its voltage modulation. Specifically, for medium voltage applications with relatively small number of submodules, the voltage modulation techniques impact on the MMC performance needs to be studied. This work provides an extensive review of the carrier-based pulse with modulation (CB-PWM) techniques proposed to be applied on previous multilevel inverter versions. The CB-PWM methods were adapted to be compatible with an additional cell ranking and selection algorithm to ensure equal energy distribution on the arm cells. The state-of-the-art of zero sequence signals (ZSS) applied on three-phase inverters is also reviewed. The alliance between the ZSS with the CB-PWM, as well as the nearest level modulation (NLM), has an important impact on the MMC harmonic content, efficiency and voltage ripple of its cells capacitors. A 15 MW 28-cell-based MMC is used to investigate each particular combination between the modulation method and the common mode ZSS.