| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $129.13 | $129.13 | $129.13 |
Cigna
| Facility | 26 | $114.94 | $114.94 | $114.94 |
Health Alliance Plan
| Facility | 26 | $82.85 | $82.85 | $129.13 |
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 | $129.13 | $129.13 | $129.13 |
Cigna
| Facility | 26 | $114.94 | $114.94 | $114.94 |
Health Alliance Plan
| Facility | 26 | $82.85 | $82.85 | $129.13 |