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Oklahoma rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $8,317.64 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $18.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $19.50 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $14.79 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $16.98 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
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