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Missouri rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $20 · 10th–90th $15–$650%20%10th90th$20Professionalmedian $15 · 10th–90th $15–$260%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
$15.49 / $19.95 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $27.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $16.22 / $52.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $18.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.38 / $26.30 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $21.38 / $85.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $15.49 / $18.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $19.05 / $20.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $15.49 / $19.05