| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $158.85 | $158.85 | $158.85 |
Midlands
| Facility | 26 | $521.45 | $521.45 | $521.45 |
Sanford Health Plan
| Professional | 26 | $199.39 | $267.81 | $305.33 |
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 | $158.85 | $158.85 | $158.85 |
Midlands
| Facility | 26 | $521.45 | $521.45 | $521.45 |
Sanford Health Plan
| Professional | 26 | $199.39 | $267.81 | $305.33 |