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Nebraska 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
$40.28 / $81.56 / $81.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.78 / $81.56 / $81.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $58.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.11 / $78.43 / $138.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.11 / $40.11 / $40.11