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Illinois rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $27.32 / $5,592.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.61 / $20.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.30 / $89.71 / $297.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.60 / $23.42 / $42.03
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.29 / $20.29 / $20.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $19.22