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Indiana rates for HCPCS G2215

Take home supply of nasal naloxone; 2-pack of 4 mg per 0.1 ml nasal spray (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.45 / $78.45 / $78.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.43 / $78.45 / $80.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.86 / $25.86 / $49.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.68 / $25.86 / $35.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.13 / $48.16 / $54.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.14 / $34.14 / $58.13