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HCPCS J0875

Injection, dalbavancin, 5 mg

Current code39 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$18.26 – $31.652 plans$9.14 – $14.90$22.83 – $37.23
Cascade Valley HospitalArlington$15.12 – $14,30211 plans$1,968 – $11,442$2,459 – $14,302
Deaconess Medical CenterSpokaneFile dated 2026-08-27$20.76 – $35.382 plans$11.70 – $19.39$29.25 – $48.47
EvergreenHealth Medical CenterKirkland$15.12 – $10,13425 plans$8,718$10,897
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$2,400$3,428
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$13.47 – $27.033 plans$9.14 – $14.82$22.83 – $37.03
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$13.71 – $27.103 plans$9.30 – $14.86$23.24 – $37.13
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$13.71 – $27.273 plans$9.30 – $14.95$23.24 – $37.36
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$21.80 – $34.902 plans$12.12 – $19.39$30.28 – $48.47
Olympic Medical CenterPort AngelesFile dated 2026-06-24$1,822 – $3,2606 plans$2,608$3,260
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01—$8,011 – $8,027$16,022 – $16,054
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$2,618$3,740
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$2,962$5,695
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$2,618$3,740
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$2,095 – $2,618$2,993 – $3,740
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$2,333$4,486
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$2,618$3,740
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$2,817 – $3,173$4,024 – $4,533
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$2,962$5,695
Seattle Children's HospitalSeattle$5,422 – $9,64098 plans$10,042$10,042
Skagit Valley HospitalMount Vernon$15.29 – $13,58710 plans$1,968 – $11,442$2,459 – $14,302
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$2,547$5,307
Swedish IssaquahIssaquahFile dated 2026-04-01—$2,547$5,307
Swedish Medical CenterSeattleFile dated 2026-04-01—$2,547$5,307
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$2,547$5,307
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$13.47 – $27.543 plans$9.14 – $15.10$22.83 – $37.73
Virginia Mason Medical CenterSeattle$42.71 – $53.354 plans$34.01$66.69
Yakima Valley MemorialYakimaFile dated 2026-08-27$13.01 – $45.731 plan$9.30 – $32.67$23.23 – $81.66

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Hospital outpatient payment (national)
$9.44 (APC 1823)
Surgery center payment (national)
$9.44