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New Mexico rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $23.99 / $45.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.85 / $42.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $79.43 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $20.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $14.45 / $14.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $30.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49