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North Carolina rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.32 / $6,945.11 / $14,152.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $15.61 / $30.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.72 / $40.31 / $45.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $14.73 / $15.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $21.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.32 / $18.57 / $23.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.58 / $14.58 / $14.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $24.20
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00