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Colorado rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $31.10 / $9,762.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $16.48 / $18.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.17 / $27.41 / $49.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $22.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $18.76 / $25.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.71 / $17.17 / $25.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61