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Arizona rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.98 / $37.54 / $179.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.79 / $14.13 / $87.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.79 / $41.45 / $69.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.77 / $11.30 / $72.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $18.36 / $75.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $11.68 / $11.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36