| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $158.49 | $158.49 | $158.49 |
Midlands
| Professional | 26 | $309.03 | $338.84 | $380.19 |
Sanford Health Plan
| Professional | 26 | $194.98 | $269.15 | $302.00 |
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 | $158.49 | $158.49 | $158.49 |
Midlands
| Professional | 26 | $309.03 | $338.84 | $380.19 |
Sanford Health Plan
| Professional | 26 | $194.98 | $269.15 | $302.00 |