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South Carolina 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
$53.24 / $131.47 / $415.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.93 / $18.91 / $40.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $2.42 / $100.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $29.09 / $34.90
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.93 / $16.11 / $46.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36