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Washington 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
$40.34 / $92.04 / $92.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.36 / $92.04 / $94.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $135.43
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.70 / $45.89 / $150.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $58.13
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.24 / $41.51 / $79,999.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.15 / $92.15 / $92.15