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Pennsylvania 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
$804.32 / $1,048.16 / $1,471.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.46 / $976.84 / $1,302.45
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,459.92 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.65 / $1,196.15 / $1,973.55
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.06 / $76.06 / $76.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.87 / $1,842.10 / $2,429.04
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.70 / $1,304.59 / $1,323.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$804.32 / $1,048.16 / $1,471.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.85 / $1,021.01 / $1,476.75
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.46 / $1,232.97 / $2,465.94
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.61 / $46.61 / $46.61
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.57 / $1,077.57 / $1,077.57
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.65 / $1,103.36 / $1,145.44
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.36 / $1,079.49 / $1,212.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.59 / $1,197.51 / $1,989.96