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Kansas rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $20 · 10th–90th $16–$6,4570%20%10th90th$20Professionalmedian $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 / $69.18 / $35,481.34
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $19.95
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $20.42 / $20.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $24.55 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $18.20 / $23.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $20.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $16.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $20.42