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Montana rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $18 · 10th–90th $16–$870%50%10th90th$18Professionalmedian $16 · 10th–90th $15–$430%20%40%10th90th$16$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $42.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $40.74 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $17.78 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $17.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $46.77
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $46.77
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $17.78 / $45.71
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $21.38 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49