| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.44 | $17.44 | $17.44 | |
Aetna
| Professional | $17.44 | $17.44 | $17.44 | |
Molina
| Professional | $22.80 | $24.92 | $60.00 | |
United
| Professional | $19.96 | $21.01 | $21.01 |
Gadofosveset Trisodium Inj
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.44 | $17.44 | $17.44 | |
Aetna
| Professional | $17.44 | $17.44 | $17.44 | |
Molina
| Professional | $22.80 | $24.92 | $60.00 | |
United
| Professional | $19.96 | $21.01 | $21.01 |