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Maine 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
$833.70 / $944.86 / $1,111.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.70 / $1,020.43 / $1,470.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $983.87 / $1,839.47
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.87 / $1,268.69 / $2,649.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.70 / $1,107.07 / $1,511.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.36 / $1,517.93 / $2,498.96