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Maine rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.36 / $186.19 / $595.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $14.13 / $14.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.11 / $35.11 / $35.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $13.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.36 / $28.40 / $526.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $14.13 / $28.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $54.87