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Texas 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
$2.11 / $2.38 / $5.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.16 / $2.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.95 / $3.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $1.98 / $1.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.09
Providence
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 / $2.24
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.02