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Massachusetts rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $15.79 / $270.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.81 / $14.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.76 / $33.90 / $75.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $46.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.19 / $14.50 / $30.90
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.52 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $24.08
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $46.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $46.64