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Tennessee rates for HCPCS J0875

Injection, Dalbavancin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $4,221.67 / $7,713.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $18.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.35 / $21.35 / $21.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $18.14