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South Carolina rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.39 / $6,021.96 / $11,583.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $16.39 / $25.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $23.24 / $37.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.23 / $19.52 / $23.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.39 / $19.67 / $39.65
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.81 / $27.81 / $27.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61