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Louisiana rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $79.87 / $248.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.47 / $14.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.15 / $17.41 / $21.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.15 / $14.15 / $14.43
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $41.77 / $41.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $11.36
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 / $23.73