go back

Tennessee rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $4,265.80 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $18.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.85 / $15.85
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $16.60 / $19.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $17.38