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Michigan 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
$31.15 / $41.54 / $1,261.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.37 / $966.15 / $1,302.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.07 / $1,108.07 / $1,108.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.79 / $51.79 / $1,295.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.89 / $53.86 / $69.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.93 / $1,077.57 / $1,472.74
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.42 / $1,059.44 / $1,218.34
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $1,059.44 / $1,343.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.74 / $1,202.69 / $1,729.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.94 / $1,201.21 / $1,641.71