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Arizona rates for HCPCS 00104

Anesthesia Electroconvulsive Therapy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$454.73 / $462.56 / $495.15
Medica
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$39.50 / $39.50 / $52.00
Medica
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$39.50 / $39.50 / $52.00
Medica
Facility/Professional
Facility
Modifier
QY
Low / Median / High Price
$39.50 / $39.50 / $52.00