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Illinois rates for HCPCS 00104

Anesthesia for electroconvulsive therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$61.66 / $61.66 / $97.72
Aetna
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$363.08 / $630.96 / $812.83
Ambetter
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$457.09 / $457.09 / $457.09