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Minnesota rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $11.36 / $317.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $87.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $29.20 / $96.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.34 / $11.68 / $24.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.92 / $51.48 / $62.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.22 / $16.62 / $18.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.80 / $46.98 / $58.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.09 / $13.09 / $17.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $19.73 / $63.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $11.68 / $21.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $20.59