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Missouri rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $44.67 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $11.22 / $44.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $12.02 / $29.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.48 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.22 / $11.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $75.86 / $138.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $11.75 / $14.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $17.38 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $11.22 / $14.13