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Alabama rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $15.60 / $16,380.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $26.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,177.85 / $6,283.58 / $8,453.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $17.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $27.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61