What does code J0875 cost?

Across the published hospital price files, the disclosed cash price for J0875 ranges from $40.07 to $5,390. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Will this be my final bill?

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

J0875 is the billing code hospitals use to identify "Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial" on their published price files. We use it to line up the same service across different hospitals.

Why do prices for this code differ between hospitals?

Each hospital sets its own prices and negotiates separately with each insurer, so the disclosed price for the same code can vary widely from one hospital to another — and even between plans at a single hospital. Comparing the published figures is what this page is for; a difference does not by itself mean one hospital is better or worse.

What this page is not

It is not a quote, a guarantee, or medical advice. It shows what hospitals have published for this code, so you can compare and ask informed questions — your actual cost depends on your insurance, the exact services performed, and the care setting.

J0875

HCPCS

Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial

Verified from hospital fileNot a bill estimate

iDirect answer

Based on the latest published hospital price files, code J0875 (Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial) appears at 33 hospitals with disclosed cash prices from $40.07 to $5,390. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Published-price availability

hospitals publish a price

list this service without a published price

Cash

List

Negotiated

Allowed

A blank price (“—”) means a hospital names this service but did not publish a dollar amount — it is not a free service or a $0 price.

Compare J0875 prices

Filter by hospital, city, setting, or payer — the summary and charts update with your filters.

Based on hospital-published prices verified from each hospital’s own file. Coverage expands as data is verified.

Published cash prices for code J0875 vary by about 135× across the 32 hospitals with disclosed prices here — from $40.07 to $5,390. Shopping around can matter.

Hospitals

Prices shown

$40.07

Lowest cash

$5,390

Highest cash

code J0875 cash price32 disclosed · 32 hospitals

$40.07median ~$3,523$5,390

Lowest cash price by hospital

Advocate Illinois Masonic Medical Center$40.07
Aurora Medical Center Bay Area$50.07
Aurora Medical Center Grafton$53.77
Aurora Medical Center Kenosha$56.36
Endeavor Health Edward Hospital$85.17
Henderson Hospital$1,463

Cash price by city

Reflects your current filters.

Cash price by city$40.07 – $1,463

Chicago · 1 hospital$40.07
Marinette · 1 hospital$50.07
Grafton · 1 hospital$53.77
Kenosha · 1 hospital$56.36
Naperville · 1 hospital$85.17
Henderson · 1 hospital$1,463

35 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial Inpatient & outpatient	Endeavor Health Edward Hospital	J0875 HCPCS	$85.17	$85.17	—	—
Injection, dalbavancin Outpatient	Endeavor Health Edward Hospital	J0875 HCPCS	—	—	$15.00 – $38.15	—
Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial Inpatient & outpatient	University of Chicago Medical Center	J0875 HCPCS	—	—	—	—
Injection, dalbavancin Outpatient	University of Chicago Medical Center	J0875 HCPCS	—	—	—	—
DALVANCE 500 MG IV SOLR Outpatient	Advocate Illinois Masonic Medical Center	J0875 HCPCS	$80.14	$40.07	$22.55 – $67.64	—
dalbavancin 500 mg Recon Soln 1 Each Vial Outpatient	Froedtert Hospital	J0875 HCPCS	$9,622	$5,292	$13.40 – $8,323	—
dalbavancin 500 mg Recon Soln 1 Each Vial Outpatient	Froedtert Menomonee Falls Hospital	J0875 HCPCS	$9,800	$5,390	$14.89 – $8,820	—
DALVANCE 500 MG IV SOLR Inpatient	Aurora Medical Center Bay Area	J0875 HCPCS	$100	$50.07	$60.08 – $84.71	—
DALVANCE 500 MG IV SOLR Inpatient	Aurora Medical Center Grafton	J0875 HCPCS	$108	$53.77	$64.52 – $91.41	—
DALVANCE 500 MG IV SOLR Inpatient	Aurora Medical Center Kenosha	J0875 HCPCS	$113	$56.36	$67.63 – $95.80	—
dalbavancin 500 mg Recon Soln 1 Each Vial Inpatient	Froedtert West Bend Hospital	J0875 HCPCS	$9,800	$5,390	$4,900 – $9,310	—
DALBAVANCIN HCL 500 MG IV SOLR Inpatient	Henderson Hospital	J0875 HCPCS	$4,876	$1,463	$1,414 – $4,729	—
DALBAVANCIN HCL 500 MG IV SOLR Inpatient	Deaconess Gibson Hospital	J0875 HCPCS	$5,337	$2,829	$2,829 – $4,804	—
DALBAVANCIN HCL 500 MG IV SOLR Inpatient	Deaconess Illinois Medical Center	J0875 HCPCS	$20,282	$3,854	$3,854 – $18,254	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Outpatient	Texas Health Presbyterian Hospital Allen	J0875 HCPCS	$5,871	$3,523	$15.61 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Outpatient	Texas Health Harris Methodist Hospital Alliance	J0875 HCPCS	$5,871	$3,523	$15.61 – $5,525	—
DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT) Inpatient & outpatient	Providence Seward Hospital	J0875 HCPCS	$5,729	$4,468	—	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Arlington Memorial Hospital	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Outpatient	Texas Health Harris Methodist Hospital Azle	J0875 HCPCS	$5,871	$3,523	$15.61 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Harris Methodist Hospital Cleburne	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,636	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Outpatient	Texas Health Presbyterian Hospital Dallas	J0875 HCPCS	$5,871	$3,523	$15.61 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Presbyterian Hospital Denton	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Presbyterian Hospital Flower Mound	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Harris Methodist Hospital Fort Worth	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,525	—
DALBAVANCIN 500 MG INTRAVENOUS SOLN [125669] Inpatient	Texas Health Hospital Frisco	J0875 HCPCS	$5,871	$3,523	$2,030 – $5,525	—

How to read these prices

Cash price: The discounted self-pay price for paying directly, without insurance.
List price: The hospital’s full undiscounted charge — rarely what anyone pays.
Negotiated rate: A rate for a specific insurer and plan; your share depends on your benefits.
Allowed amount: A historical reference for what was actually allowed, where disclosed.

Hospitals that publish J0875 prices

Open a hospital to see this code in the context of its full published prices.

Code J0875: frequently asked

What does code J0875 cost?: Across the published hospital price files, the disclosed cash price for J0875 ranges from $40.07 to $5,390. This is public hospital price transparency data, not a guaranteed estimate of your bill.
Will this be my final bill?: Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.
What is code J0875?: J0875 is the billing code hospitals use to identify "Dalvance: 1 Vial In 1 Package (57970-100-01) / 25 Ml In 1 Vial" on their published price files. We use it to line up the same service across different hospitals.
Why do prices for this code differ between hospitals?: Each hospital sets its own prices and negotiates separately with each insurer, so the disclosed price for the same code can vary widely from one hospital to another — and even between plans at a single hospital. Comparing the published figures is what this page is for; a difference does not by itself mean one hospital is better or worse.
What this page is not: It is not a quote, a guarantee, or medical advice. It shows what hospitals have published for this code, so you can compare and ask informed questions — your actual cost depends on your insurance, the exact services performed, and the care setting.

All CPT / HCPCS codes Browse hospitals How to read this data

Hospitals publishing code J0875 by state

Alaska hospital prices Illinois hospital prices Indiana hospital prices Kentucky hospital prices Texas hospital prices Wisconsin hospital prices