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Nebraska rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $18 · 10th–90th $15–$360%20%10th90th$18Professionalmedian $15 · 10th–90th $15–$430%50%10th90th$15$20.0$100.0$500.0$2.0K$10.0K

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
$15.49 / $24.55 / $9,772.37
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
$13.18 / $16.98 / $17.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.60 / $16.98 / $17.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $19.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $29.51 / $85.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $16.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $18.62 / $18.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $15.14 / $30.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $15.49 / $20.42