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Arizona rates for HCPCS G2083

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 greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.34 / $771.04 / $1,063.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.31 / $976.84 / $1,302.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.91 / $1,554.91 / $1,554.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.86 / $22.86 / $110.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.00 / $192.16 / $1,102.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.61 / $46.61 / $46.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.57 / $1,077.57 / $1,077.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $1,020.43 / $1,713.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.90 / $1,138.13 / $3,918.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.56 / $1,112.71 / $2,214.71