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South Dakota 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
$113.14 / $113.14 / $113.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $81.59 / $113.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.97 / $58.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.22 / $93.74 / $151.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.22 / $40.22 / $40.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.89 / $45.89 / $45.89