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Montana rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Facilitymedian $76 · 10th–90th $26–$3090%10%20%10th90th$76Professionalmedian $12 · 10th–90th $11–$690%50%10th90th$12$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $169.82 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $11.48 / $69.18
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $46,773.51 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $14.79
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $26.92 / $67.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $26.92 / $67.61
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $120.23
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $13.18 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $11.22 / $11.22