8600 Maddox Drive, Ste 200, Lincoln, NE 68520
Spravato® Treatment Cost Estimate
Estimated Patient Responsibility
Patient name
Insurance plan
Annual deductible
Deductible met to date
Out-of-pocket max (OOP max)
OOP met to date
Copay per visit
Coinsurance %
Copay applies
After deductible only
Deductible Progress
$0 met
$0 remaining
Out-of-Pocket Max Progress
$0 met
$0 remaining
Estimated Costs
Initial evaluation (90792)
$0
Estimated per Spravato visit
$0
Estimated weekly cost (2 visits)
$0
Spravato® Savings Programs
Eligible patients may pay as little as $10 medication cost and $0 observation cost after rebates. Ask your coordinator for details.
Disclaimer: This estimate is not a guarantee of coverage or payment. Final responsibility is determined by the insurance carrier.
Service Rates (Staff Use)
90792 Allowed: 90792 Manual:
Spravato Allowed: Spravato Manual: