ESKETAMINE, NASAL SPRAY

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Generation details were not recorded for this description.

Original text from hospital filings

SPRAVATO (84 MG DOSE) 28 MG-DEVICE NA SOPK

Payers reporting HCPCS S0013

Payer pricing summary

Low

$11

Average

$536

Median

$321

High

$1.8k

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +11 other terms	159	$28	$49	$34	70%	—	$12 – $130
2	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	107	$59	$242	$246	102%	—	$1 – $826
3	Aetna fee schedule · outpatient · +17 other terms	77	$30	$33	$29	88%	—	$1 – $163
4	UnitedHealthcare fee schedule · outpatient · +16 other terms	46	$17	$31	$40	129%	—	$1 – $163
5	Anthem facility · fee schedule · outpatient · +12 other terms	40	$16	$401	$557	139%	—	$13 – $1.3k
6	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$520	$472	$158	33%	—	$193 – $817
7	Molina facility · case rate · outpatient · +8 other terms	27	$171	$151	$62	41%	—	$78 – $308
8	Caresource fee schedule · outpatient · +4 other terms	24	$16	$15	$3	22%	—	$1 – $18
9	Humana fee schedule · outpatient · +9 other terms	20	$44	$46	$52	112%	—	$1 – $171
10	Optum facility · case rate · outpatient · +4 other terms	13	$164	$171	$57	33%	—	$74 – $279
11	Wellmark fee schedule · both · +9 other terms	13	$15	$15	—	—	—	$15 – $15
12	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$12	$13	$3	26%	—	$6 – $15
13	Bcbs Nj fee schedule · outpatient	12	$14	$14	—	—	—	$14 – $14
14	Aetna Better Health fee schedule · outpatient · +4 other terms	11	$14	$14	$1	6%	—	$14 – $15
15	Bcbs Nc fee schedule · both · +1 other terms	11	$15	$15	$0	3%	—	$14 – $15
16	Highmark fee schedule · outpatient · +4 other terms	10	$17	$17	—	—	—	$17 – $17
17	Medica fee schedule · both · +6 other terms	9	$23	$22	$7	32%	—	$11 – $29
18	Ucare fee schedule · both	9	$11	$11	$0	3%	—	$11 – $11
19	Medicaid fee schedule · both · +5 other terms	8	$77	$78	$4	5%	—	$74 – $84
20	Phcs percent of total billed charges · bothfrom % of charges · +5 other terms	8	$27	$27	—	—	—	$27 – $27
21	WellCare fee schedule · both · +3 other terms	8	$77	$78	$1	1%	—	$76 – $80
22	Amerihealth Caritas facility · case rate · outpatient · +4 other terms	7	$86	$87	$3	3%	—	$86 – $93
23	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +4 other terms	7	$1.4k	$1.7k	$2.2k	131%	—	$55 – $8.6k
24	Bcbs La fee schedule · outpatient	6	$13	$13	$1	9%	—	$13 – $16
25	First Health facility · fee schedule · outpatient · +6 other terms	4	$39	$39	—	—	—	$39 – $39

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