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Indiana rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $30 · 10th–90th $16–$8,9130%20%10th90th$30Professionalmedian $15 · 10th–90th $15–$200%50%90th$15$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$15.85 / $43.65 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $22.39 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $28.84
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $23.44 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $41.69 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $19.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $30.90 / $30.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $30.90