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Wyoming rates for HCPCS J0875

Injection, Dalbavancin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $15.55 / $15.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $21.35 / $21.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $14.73 / $14.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $22.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $15.61 / $15.61