go back

Kansas 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
$17.29 / $54.55 / $155.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $12.27 / $42.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.30 / $31.11 / $100.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.28 / $12.28 / $12.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $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
$13.66 / $22.22 / $55.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $11.68 / $18.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $19.30