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Idaho rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $15.98 / $231.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $12.49 / $14.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.36 / $11.36
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
$12.49 / $15.99 / $264.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $14.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.63 / $13.63 / $14.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $18.18