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Washington rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $22 · 10th–90th $15$370%20%10th90th$22Professionalmedian $17 · 10th–90th $15$190%50%10th90th$17$10.0$50.0$200.0$1.0K$5.0K

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
$16.98 / $26.30 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $16.98 / $30.20
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $22.91 / $48.98
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $18.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $15.85 / $25.70
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $18.20 / $42.66
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $18.20 / $18.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $19.05 / $48.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $19.50