go back

Alaska rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.88 / $28.63 / $101.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.71 / $29.04 / $2,970.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.53 / $41.53 / $41.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $50.26
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.55 / $29.89 / $46.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.84 / $41.53 / $70.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $16.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $23.42 / $31.49