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South Carolina 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
$2.16 / $2.16 / $8.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.24 / $2.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.59 / $6.32 / $6.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $5.88 / $5.88
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $2.38 / $3.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24