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Connecticut rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.23 / $24.79 / $4,574.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.23 / $16.23 / $16.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $23.73 / $49.64
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
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.20 / $16.20 / $19.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.05 / $15.61 / $19.64