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Oklahoma rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $21 · 10th–90th $14–$9,1200%10%20%10th90th$21Professionalmedian $15 · 10th–90th $15–$170%50%10th90th$15$10.0$50.0$200.0$1.0K$5.0K$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
$15.85 / $8,317.64 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $20.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $19.50 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $39.81 / $42.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $16.98 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $25.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49