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South Dakota 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
$36.31 / $645.65 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $645.65 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $758.58 / $1,230.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $676.08 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $977.24 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $81.28 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $954.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $776.25 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $467.74 / $1,412.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $51.29 / $1,258.93