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Nebraska 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
$11.68 / $21.84 / $317.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.68 / $87.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.64 / $12.86 / $12.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $12.73 / $13.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $13.09 / $16.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.19 / $56.53 / $285.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.57 / $11.68 / $28.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.43 / $29.06 / $89.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.01 / $38.64 / $135.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.79 / $11.36 / $12.50