go back

Mississippi rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.39 / $4,221.67 / $6,442.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $18.73 / $36.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.30 / $14.30 / $15.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $18.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $15.61 / $20.28