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Ohio rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $28 · 10th–90th $15$9,7720%10%10th90th$28Professionalmedian $15 · 10th–90th $15$240%50%10th90th$15$0.2$2.0$20.0$200.0$2.0K$20.0K

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 / $28.84 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $20.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $28.18 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $17.78 / $28.18
Aultcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $20.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $31.62 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.49
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $15.14 / $33.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $27.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $19.50 / $22.39
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $25.12 / $34.67
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $33.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $16.98