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Michigan 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
$88.91 / $91.87 / $91.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.43 / $88.91 / $91.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.22 / $93.60 / $93.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.92 / $92.22 / $124.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $58.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.69 / $48.59 / $91.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.69 / $49.49 / $91.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,500.00