| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $128.05 | $167.75 | $228.71 |
Medica
| Facility | 26 | $295.85 | $455.64 | $455.64 |
Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $128.05 | $167.75 | $228.71 |
Medica
| Facility | 26 | $295.85 | $455.64 | $455.64 |