go back

Kansas rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.35 / $34,449.82 / $35,843.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $16.86 / $21.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.70 / $19.16 / $23.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.07 / $17.07 / $17.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.50 / $18.19 / $23.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $19.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $20.92