go back

Oregon rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $22.39 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.85 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $21.88 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $33.88 / $39.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $16.60 / $30.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $16.60 / $20.42
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $19.50 / $32.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $21.88 / $45.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $16.98 / $79.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $25.12 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $37.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49