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Michigan rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $35 · 10th–90th $16–$620%10%20%10th90th$35Professionalmedian $15 · 10th–90th $15–$210%50%10th90th$15$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $44.67 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $25.12
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.62 / $34.67 / $69.18
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.79 / $14.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $15.49
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $30.90 / $50.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $16.22 / $23.99
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $15.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $16.60