go back

Louisiana 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 / $3.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $2.64 / $2.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.56
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.64