go back

South Carolina rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $26 · 10th–90th $16–$6,7610%10%20%10th90th$26Professionalmedian $16 · 10th–90th $15–$250%20%40%10th90th$16$10.0$50.0$200.0$1.0K$5.0K

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
$16.22 / $66.07 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $25.12
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $21.88 / $40.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $18.20 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $21.38 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $19.50 / $44.67
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $25.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $20.42