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Georgia rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $9,176.54 / $26,609.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.77 / $28.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $25.41 / $57.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.89 / $15.61 / $15.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $30.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.06 / $46.00 / $72.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $19.63