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Utah 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
$537.03 / $616.60 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $660.69 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $91.20 / $1,096.48
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $851.14 / $1,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $1,071.52 / $1,380.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $575.44 / $1,230.27