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Washington, DC rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $48.98 / $58.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.85
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $23.99 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $15.49 / $15.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $15.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $25.12