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Illinois rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $28 · 10th–90th $15$6,1660%10%20%10th90th$28Professionalmedian $15 · 10th–90th $15$220%50%10th90th$15$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $27.54 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $20.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $85.11 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $28.18 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $31.62 / $100.00
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $20.42 / $20.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $25.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $16.60