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Pennsylvania rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $40 · 10th–90th $16$13,8040%10%10th90th$40Professionalmedian $15 · 10th–90th $15$230%50%90th$15$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$16.60 / $40.74 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $30.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $16.98 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $16.22 / $16.22
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $52.48 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $26.30 / $26.30
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $32.36 / $53.70
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $22.91 / $45.71
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $16.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $17.38 / $18.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.90 / $15.49 / $18.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $21.38