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Wisconsin rates for HCPCS J0875

Injection, dalbavancin, 5 mg

Facilitymedian $30 · 10th–90th $16$18,1970%20%10th90th$30Professionalmedian $15 · 10th–90th $15$310%50%90th$15$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$16.22 / $30.90 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $26.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.62 / $18.62 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $19.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $38.02 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $19.95 / $28.84
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $15.49 / $33.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $30.90 / $30.90
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $15.49 / $33.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $25.12
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $16.22 / $16.22
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $20.89 / $46.77
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $15.49
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $20.42 / $25.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.49 / $36.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $15.49 / $21.38