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South Dakota rates for HCPCS J1320

Injection, amitriptyline HCl, up to 20 mg

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
$2.19 / $2.64 / $2.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.55 / $6.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $4.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.46