HCPCS J0877

Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg

Current code8 hospitals with prices

Description from CMS's HCPCS Level II code file.

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.

Prices for HCPCS J0877 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Cascade Valley HospitalArlington	$97.17 – $3311 plan	$77.74 – $264	$97.17 – $331
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01	—	$22.44 – $101	$44.89 – $202
PeaceHealth Peace Island Medical CenterFriday Harbor	—	$19.63 – $177	$30.20 – $272
PeaceHealth Southwest Medical CenteVancouver	—	$91.39 – $170	$141 – $261
PeaceHealth St John Medical CenterLongview	—	$107 – $170	$165 – $261
PeaceHealth St Joseph Medical CenterBellingham	—	$48.36 – $170	$74.40 – $261
PeaceHealth United General Medical CenterSedro Woolley	—	$107 – $170	$165 – $261
Skagit Valley HospitalMount Vernon	$3,3011 plan	$77.74 – $264	$97.17 – $331

Lowest and highest amounts each hospital lists for this code as an outpatient, 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

CMS publishes no national amount for this code.