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New Mexico rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $33.11 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $15.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $22.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.33 / $15.14 / $19.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $9.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $12.88