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Tennessee rates for HCPCS 00104

Anesthesia for electroconvulsive therapy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$490.98 / $547.64 / $578.50
Ambetter
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$272.08 / $272.08 / $306.00
Lucent Health
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$37.00 / $37.00 / $39.50
Lucent Health
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$37.00 / $37.00 / $39.50
Lucent Health
Facility/Professional
Facility
Modifier
QY
Low / Median / High Price
$37.00 / $37.00 / $39.50