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Washington rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.88 / $26.21 / $35.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $17.17 / $20.53
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $23.69 / $45.79
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $16.93 / $21.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $37.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $19.14
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $19.44 / $32.47
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.76 / $24.47 / $42.82
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.31 / $16.93 / $21.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $18.95 / $36.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61