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Louisiana rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $16.32 / $54.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.77 / $18.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.18 / $14.43 / $17.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.13 / $17.13 / $17.47
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $3,568.58 / $3,568.58
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.61 / $21.35