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New Hampshire rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $26 · 10th–90th $15–$660%10%10th90th$26Professionalmedian $15 · 10th–90th $15–$280%50%10th90th$15$20.0$100.0$500.0$2.0K

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 / $19.95 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $39.81 / $66.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $29.51 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $25.12 / $28.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $22.91