| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $154.06 | $200.28 | $200.28 |
Cigna
| Facility | 26 | $212.10 | $212.10 | $312.39 |
Kaiser Permanente
| Professional | 26 | $200.28 | $249.58 | $577.82 |
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(s), followed by contrast material(s) and further sequences
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $154.06 | $200.28 | $200.28 |
Cigna
| Facility | 26 | $212.10 | $212.10 | $312.39 |
Kaiser Permanente
| Professional | 26 | $200.28 | $249.58 | $577.82 |