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Vermont 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
$838.45 / $950.24 / $1,117.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.45 / $1,051.66 / $1,361.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.57 / $1,077.57 / $1,077.57
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.57 / $1,077.57 / $1,627.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.90 / $1,580.43 / $3,529.26