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Utah rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Facilitymedian $85 · 10th–90th $60–$3090%10%20%10th90th$85Professionalmedian $11 · 10th–90th $11–$170%20%10th90th$11$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $12.88 / $18.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $17.38 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $9.33
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $9.77
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.51 / $9.33 / $13.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $11.22 / $11.22