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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
$33.88 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $79.43 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $57.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $81.28 / $138.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $33.88 / $33.88