| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $1.00 | |
Aetna
| Professional | $1.00 | $1.00 | $1.15 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 | |
United
| Professional | $0.56 | $0.56 | $0.56 |
Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $1.00 | |
Aetna
| Professional | $1.00 | $1.00 | $1.15 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 | |
United
| Professional | $0.56 | $0.56 | $0.56 |