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Massachusetts rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $24.55 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $30.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $37.15 / $50.12
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.49 / $19.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $56.23 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $26.30
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $4,786.30
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $37.15 / $50.12
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.49 / $19.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $21.88