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New Hampshire 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
$40.33 / $78.65 / $94.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.65 / $92.20 / $98.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.39 / $15.39 / $35.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00