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Florida rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $28.88 / $14,382.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $17.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $15.61 / $16.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.91 / $15.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $21.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.61