go back

Minnesota rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $31.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $40.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $19.50 / $38.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.44 / $15.55 / $15.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.43 / $50.64 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.02 / $18.66 / $20.14
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.38 / $46.22 / $58.00
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.86 / $15.86 / $21.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $22.74 / $33.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $27.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $21.54