| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $152.90 | $152.90 | $160.54 |
Cigna
| Facility | 26 | $135.26 | $135.26 | $135.26 |
Health Alliance Plan
| Facility | 26 | $104.35 | $104.35 | $152.90 |
Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $152.90 | $152.90 | $160.54 |
Cigna
| Facility | 26 | $135.26 | $135.26 | $135.26 |
Health Alliance Plan
| Facility | 26 | $104.35 | $104.35 | $152.90 |