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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

Other government program: TRICARE, VA, Indian Health Service, workers' compensation, or another public program.

HospitalOther government program rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$9.14 – $14.90$22.83 – $37.23
Cascade Valley HospitalArlington—$1,968 – $11,442$2,459 – $14,302
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$11.70 – $19.39$29.25 – $48.47
EvergreenHealth Medical CenterKirkland$15.891 plan$8,718$10,897
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$2,400$3,428
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$9.14 – $14.82$22.83 – $37.03
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$9.30 – $14.86$23.24 – $37.13
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$9.30 – $14.95$23.24 – $37.36
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$12.12 – $19.39$30.28 – $48.47
Olympic Medical CenterPort AngelesFile dated 2026-06-24—$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$4,1171 plan$10,042$10,042
Skagit Valley HospitalMount Vernon—$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—$9.14 – $15.10$22.83 – $37.73
Virginia Mason Medical CenterSeattle—$34.01$66.69
Yakima Valley MemorialYakimaFile dated 2026-08-27—$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