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Maryland rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.63 / $52.68 / $326.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $15.65
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $14.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $49.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $18.41
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.90 / $14.90 / $14.90