go back

Kentucky rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $15.61 / $8,452.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.68 / $18.41 / $31.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $15.61 / $15.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $16.88 / $24.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $17.17 / $24.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.06 / $15.61 / $29.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.61 / $15.61