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West Virginia rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.02 / $44.06 / $139.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $11.68 / $17.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.33 / $26.33 / $26.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.36 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $38.36
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.04 / $38.90 / $109.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $54.87