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Oregon rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $19.44 / $31.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.77 / $40.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $22.08 / $31.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $16.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.31 / $34.09 / $40.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $22.32 / $33.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $17.17 / $20.29
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $19.51 / $32.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $22.08 / $33.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $18.62 / $19.51
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $23.74 / $53.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61