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Washington, DC 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
$9.99 / $27.29 / $44.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $31.65 / $53.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $11.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.66 / $9.66 / $11.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.34 / $11.36 / $18.41