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North Dakota rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $19.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $17.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $16.98 / $17.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $19.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $15.14 / $26.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $15.49 / $17.38