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South Dakota 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
$36.52 / $48.70 / $1,729.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.31 / $976.84 / $1,470.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $1,077.57 / $1,736.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $1,057.99 / $2,923.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.74 / $1,764.56 / $7,170.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.46 / $1,475.90 / $2,780.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.44 / $1,387.65 / $2,031.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.16 / $1,191.89 / $2,342.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.11 / $1,848.18 / $2,162.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.20 / $50.70 / $1,765.20