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Nebraska rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $24.55 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.49 / $42.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $16.98 / $17.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $16.98 / $17.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.85 / $19.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $21.38 / $85.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $23.99 / $23.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $15.49 / $30.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $15.49 / $20.42