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North Carolina rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $33 · 10th–90th $16–$14,1250%10%20%10th90th$33Professionalmedian $16 · 10th–90th $15–$310%20%40%10th90th$16$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$15.85 / $6,918.31 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $30.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $15.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $22.39 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $16.98
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $18.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $25.70 / $28.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $21.38
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $100.00