go back

Tennessee rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.35 / $47.23 / $243.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $14.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.00 / $42.00 / $42.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $32.92