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New Jersey rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $28.49 / $85.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.47
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.65 / $402.88 / $2,014.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $33.32 / $63.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,243.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $12.12 / $28.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $54.87