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Michigan 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
$11.70 / $45.03 / $146.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.70 / $14.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.04 / $25.29 / $47.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.97 / $6.28 / $6.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $59.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.69 / $41.04 / $92.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.70 / $15.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.06 / $13.43 / $14.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $12.05