go back

New York rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $19.95 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $26.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $12.59
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $31.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $47.86
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $11.48 / $31.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $10.23 / $16.98
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $12.02
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.75
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $20.42
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $13.49
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.75 / $30.20