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New Hampshire rates for HCPCS G2082

Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self administration, includes 2 hours post administration observation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.71 / $692.29 / $852.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $733.02 / $931.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $684.49 / $1,405.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.74 / $759.74 / $759.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.40 / $756.30 / $2,503.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.88 / $1,248.90 / $2,308.23
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.55 / $27.38 / $770.14