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Louisiana rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $16.22 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $16.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $16.98 / $17.38
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $14.79 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $17.38