HCPCS Level IIdrugActive
J0875
Injection, dalbavancin
BETOS: O1E
Effective: 2016-01-01
Description
Injection, dalbavancin, 5 mg
Medicare Part B Drug Pricing
Average Sales Price (ASP) data for Q1 2026
Drug Name
Dalvance
Manufacturer
Allergan, Inc.
HCPCS Dosage
5 MG
Billing Units
100.0000
1
NDC Products
asp
Pricing Source
Medicare Part B drugs are reimbursed at ASP + 6%. Pricing updates quarterly based on manufacturer-reported data.