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New Hampshire 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
$33.71 / $1,011.98 / $1,210.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $1,071.52 / $1,361.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $983.87 / $1,993.14
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
$40.40 / $1,072.69 / $3,551.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,319.12 / $1,844.22 / $2,970.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.55 / $27.38 / $1,126.58