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New Hampshire 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
$2.24 / $2.24 / $2.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $3.73 / $6.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.46 / $3.14