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Idaho rates for HCPCS J1320

Injection Amitriptyline Hcl Up To 20 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2.64 / $2.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.24 / $2.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.41 / $3.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.13