| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $186.36 | $186.36 | $186.36 |
Health Alliance Plan
| Facility | 26 | $173.03 | $173.03 | $186.36 |
Test Select & Admn Functl Brain Map Phys/Qhp
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $186.36 | $186.36 | $186.36 |
Health Alliance Plan
| Facility | 26 | $173.03 | $173.03 | $186.36 |