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Washington 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
$12.49 / $40.93 / $228.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $12.49 / $25.07
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $22.50 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $16.17 / $42.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $25.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $13.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $14.20 / $34.08
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.50 / $34.86 / $34.86
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.62 / $17.14 / $42.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.36 / $11.36 / $11.36