go back

Arkansas rates for HCPCS J0500

Injection Dicyclomine Hcl Up To 20 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.17 / $16.34 / $175.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $13.63 / $14.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.66 / $12.66 / $12.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.66 / $12.66 / $13.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.36 / $35.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.79 / $11.36 / $46.64