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Missouri rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $21.35 / $9,684.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $16.07 / $22.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $26.54 / $56.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $19.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.50 / $20.73 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.22 / $15.55 / $17.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $15.61 / $18.14