go back

Arkansas rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.73 / $4,221.67 / $4,442.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $18.66 / $18.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.87 / $16.87 / $16.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.14 / $16.87 / $16.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $15.61 / $16.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $18.14