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New Jersey rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $36.39 / $9,795.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.77
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.04 / $25.04 / $25.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.13 / $17.46 / $22.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.60 / $3,243.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $21.35