| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $123.03 | $123.03 | $123.03 |
Medcost
| Professional | 26 | $199.53 | $199.53 | $199.53 |
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 | $123.03 | $123.03 | $123.03 |
Medcost
| Professional | 26 | $199.53 | $199.53 | $199.53 |