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Vermont rates for HCPCS J0500

Injection Dicyclomine Hcl Up To 20 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $20.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $14.56 / $24.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $14.56 / $24.26
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.79 / $11.36 / $17.48