go back

Utah rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $79.97 / $308.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.43 / $19.68 / $30.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36