go back

Wyoming rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.85 / $94.34 / $170.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $44.40 / $44.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $10.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $16.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36