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Kentucky rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $20.89 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $16.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $18.20 / $29.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $25.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $16.22 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $66.07 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49