go back

Arizona rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.70 / $31.22 / $13,128.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.11 / $18.82 / $40.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.57 / $53.88 / $88.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.35 / $15.06 / $99.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.16 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $20.53 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61