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Utah rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $20 · 10th–90th $18–$400%20%40%10th90th$20Professionalmedian $15 · 10th–90th $15–$180%50%10th90th$15$20.0$50.0

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
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $18.20 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $22.39 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $32.36 / $45.71
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $15.14 / $18.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49