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Texas rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $64.20 / $312.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.47 / $18.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.64 / $71.88 / $155.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.96 / $26.96 / $26.96
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $31.66 / $213.92
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.77 / $41.77 / $41.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $102.30 / $399.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.76 / $11.36 / $26.97
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.50 / $1,735.81 / $3,036.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.36 / $21.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.70 / $11.36 / $20.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $14.90 / $15.34