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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
$19.95 / $29.51 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $20.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $18.20 / $23.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $9,549.93 / $25,118.86
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $19.05 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $17.78