HCPCS J0875
Injection, dalbavancin, 5 mg
Current code39 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $3,340 – $4,948 | $9.14 – $14.90 | $22.83 – $37.23 |
| Cascade Valley Hospital | $16.85 – $14,688 | $1,968 – $11,442 | $2,459 – $14,302 |
| Deaconess Medical Center | $3,056 – $3,235 | $11.70 – $19.39 | $29.25 – $48.47 |
| EvergreenHealth Medical Center | — | $8,718 | $10,897 |
| Harborview Medical Center | — | — | — |
| Island Hospital | $3,153 – $3,421 | — | — |
| Kadlec Regional Medical Center | — | $2,400 | $3,428 |
| Legacy Salmon Creek Medical Center | — | — | — |
| Mary Bridge Children's Hospital | $3,160 – $3,413 | — | — |
| MultiCare Auburn Medical Center | $3,103 – $3,352 | $9.14 – $14.82 | $22.83 – $37.03 |
| MultiCare Covington Medical Center | $3,103 – $3,352 | $9.30 – $14.86 | $23.24 – $37.13 |
| MultiCare Good Samaritan Hospital | $3,175 – $3,429 | $9.30 – $14.95 | $23.24 – $37.36 |
| MultiCare Valley Hospital | $3,034 – $3,212 | $12.12 – $19.39 | $30.28 – $48.47 |
| Olympic Medical Center | $3,906 – $4,278 | $2,608 | $3,260 |
| Overlake Hospital Medical Center & Clinics | — | $8,011 – $8,027 | $16,022 – $16,054 |
| PeaceHealth Peace Island Medical Center | — | $990 – $3,408 | $1,523 – $5,243 |
| PeaceHealth Southwest Medical Cente | $16.21 | $990 – $5,996 | $1,523 – $9,225 |
| PeaceHealth St John Medical Center | $12.16 – $16.37 | $990 – $3,408 | $1,523 – $5,243 |
| PeaceHealth St Joseph Medical Center | $16.37 | $990 – $3,408 | $1,523 – $5,243 |
| PeaceHealth United General Medical Center | — | $990 – $3,408 | $1,523 – $5,243 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $2,618 | $3,740 |
| Providence Centralia Hospital | — | $2,962 | $5,695 |
| Providence Holy Family Hospital | — | $2,618 | $3,740 |
| Providence Mount Carmel Hospital | — | $2,095 – $2,618 | $2,993 – $3,740 |
| Providence Regional Medical Center Everett | — | $2,333 | $4,486 |
| Providence St Joseph Hospital | — | $2,618 | $3,740 |
| Providence St Mary Medical Center | — | $2,817 – $3,173 | $4,024 – $4,533 |
| Providence St Peter Hospital | — | $2,962 | $5,695 |
| Seattle Children's Hospital | $2,581 – $3,264 | $10,042 | $10,042 |
| Skagit Valley Hospital | $3,057 – $4,042 | $1,968 – $11,442 | $2,459 – $14,302 |
| Swedish Edmonds Hospital | — | $2,547 | $5,307 |
| Swedish Issaquah | — | $2,547 | $5,307 |
| Swedish Medical Center | — | $2,547 | $5,307 |
| Swedish Medical Center / Cherry Hill | — | $2,547 | $5,307 |
| Tacoma General Allenmore Hospital | $3,176 – $3,430 | $9.14 – $15.10 | $22.83 – $37.73 |
| University of Washington Medical Ctr | — | — | — |
| Virginia Mason Medical Center | — | $34.01 | $66.69 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $3,035 – $3,526 | $9.30 – $32.67 | $23.23 – $81.66 |
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