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Missouri rates for HCPCS 00104

Anesthesia for electroconvulsive therapy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$482.03 / $515.58 / $629.09
Medica
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$39.50 / $39.50 / $39.50
Medica
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$39.50 / $39.50 / $39.50
Medica
Facility/Professional
Facility
Modifier
QY
Low / Median / High Price
$39.50 / $39.50 / $39.50