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New Hampshire rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.35 / $21.20 / $302.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $17.04 / $46.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $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
$15.42 / $18.91 / $35.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $45.75 / $70.17