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Washington rates for HCPCS J0500

Injection, dicyclomine HCl, up to 20 mg

Facilitymedian $23 · 10th–90th $13$1170%10%10th90th$23Professionalmedian $11 · 10th–90th $11$190%20%10th90th$11$10.0$20.0$50.0$100.0$200.0$500.0

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
$12.59 / $22.91 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $11.22 / $18.62
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $9.33
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $9.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $42.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $11.48
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.48 / $11.48 / $33.88
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $34.67 / $34.67
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $17.78 / $17.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $9.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $9.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $30.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $11.22 / $12.88
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $11.22 / $12.30