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Pennsylvania 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
$91.97 / $92.20 / $92.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.18 / $91.97 / $92.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.27 / $101.27 / $101.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $58.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.20 / $92.20 / $92.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.37 / $91.91 / $92.20
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $58.13