| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $206.25 | $206.25 | $206.25 |
Cigna
| Facility | 26 | $172.08 | $172.08 | $172.08 |
Health Alliance Plan
| Facility | 26 | $155.58 | $155.58 | $206.25 |
Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $206.25 | $206.25 | $206.25 |
Cigna
| Facility | 26 | $172.08 | $172.08 | $172.08 |
Health Alliance Plan
| Facility | 26 | $155.58 | $155.58 | $206.25 |