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Alaska rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.50 / $76.02 / $305.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.79 / $21.13 / $87.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.22 / $30.22 / $30.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $36.58
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.50 / $58.80 / $92.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.22 / $58.80 / $138.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $12.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $17.04 / $22.92