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Virginia rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $33.11 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $18.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $30.90 / $52.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $26.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $23.99 / $36.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $15.49 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $15.49 / $20.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $26.92
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $16.22 / $22.91
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $16.22 / $22.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.49 / $19.50