| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $389.05 | $389.05 | $389.05 |
Well Sense
| Facility | 26 | $63.10 | $74.13 | $74.13 |
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 | $389.05 | $389.05 | $389.05 |
Well Sense
| Facility | 26 | $63.10 | $74.13 | $74.13 |