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Alabama rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $20.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,309.57 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49