| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $121.32 | $121.32 | $121.32 |
Midlands
| Facility | 26 | $410.98 | $410.98 | $410.98 |
Sanford Health Plan
| Professional | 26 | $153.74 | $201.14 | $228.36 |
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 | $121.32 | $121.32 | $121.32 |
Midlands
| Facility | 26 | $410.98 | $410.98 | $410.98 |
Sanford Health Plan
| Professional | 26 | $153.74 | $201.14 | $228.36 |