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South Dakota rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $86.86 / $317.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.47 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.09 / $13.09 / $16.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.70 / $19.73 / $97.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.68 / $12.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.01 / $17.88 / $89.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.43 / $29.06 / $90.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.44 / $12.44 / $22.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $14.90
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $11.68 / $11.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $11.68 / $11.68