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Illinois rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.75 / $69.45 / $267.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.68 / $14.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.79 / $75.53 / $488.01
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $17.48 / $116.50
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.77 / $14.77 / $14.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $20.45