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Hawaii rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.76 / $15.76 / $15.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.78 / $22.78 / $22.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.17 / $18.73 / $21.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $18.72 / $23.42
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.91 / $18.50 / $20.12