| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $123.28 | $212.27 | $414.43 |
Cigna
| Facility | 26 | $123.42 | $135.26 | $135.26 |
Medical Mutual of Ohio
| Facility | 26 | $123.42 | $123.42 | $135.26 |
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 | $123.28 | $212.27 | $414.43 |
Cigna
| Facility | 26 | $123.42 | $135.26 | $135.26 |
Medical Mutual of Ohio
| Facility | 26 | $123.42 | $123.42 | $135.26 |