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Vermont rates for HCPCS J0875

Injection, Dalbavancin

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $26.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.68 / $17.68 / $17.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $17.62 / $29.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $17.62 / $29.37
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.35 / $15.61 / $18.14