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Pennsylvania rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $40.74 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $20.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $16.98 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $26.92 / $26.92
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $37.15 / $53.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $40.74 / $13,803.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.85 / $42.66
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $17.38 / $18.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $15.49 / $18.20
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 / $21.38