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Oklahoma rates for HCPCS J0500

Injection Dicyclomine Hcl Up To 20 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.61 / $137.51 / $419.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.27 / $12.27 / $12.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.49 / $97.72 / $152.05
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 / $21.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $21.73 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.68 / $12.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36