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Pennsylvania rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.03 / $56.16 / $187.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.47 / $87.95
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.95 / $16.39 / $2,727.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $12.32 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.79 / $11.79 / $11.79
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.56 / $39.90 / $297.86
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.95 / $15.92 / $2,618.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.03 / $54.76 / $165.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.79 / $60.46
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.93 / $1,917.17 / $2,384.98
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.36 / $11.36
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.19 / $24.19 / $28.07
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.19 / $24.19 / $28.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $20.79