| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $102.04 | $102.04 | $102.04 |
Midlands
| Facility | 26 | $333.67 | $333.67 | $333.67 |
Sanford Health Plan
| Professional | 26 | $129.77 | $170.79 | $194.72 |
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 | $102.04 | $102.04 | $102.04 |
Midlands
| Facility | 26 | $333.67 | $333.67 | $333.67 |
Sanford Health Plan
| Professional | 26 | $129.77 | $170.79 | $194.72 |