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Idaho rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $21.97 / $13,037.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $18.82 / $19.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.17 / $20.69 / $27.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $19.51 / $19.51
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.17 / $23.69 / $39.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $18.73 / $19.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61