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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
$15.61 / $43.85 / $59.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $24.59 / $41.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $15.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $13.27 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $15.61 / $25.30