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Massachusetts rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $21.70 / $9,273.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $16.23 / $18.66
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.16 / $41.83 / $85.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $19.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.75 / $19.92 / $42.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.86 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $32.42
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,765.49 / $4,765.49 / $4,765.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $23.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $26.47