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Connecticut rates for HCPCS J7639

Dornase Alpha Inhalation Solution Administered Through Dme Unit Dose Form Per Milligram (Special Coverage Instructions Apply. See Mcm: 2100.5)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.37 / $86.15 / $154.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $57.37 / $66.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.19 / $92.39 / $170.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $54.58 / $54.58
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.88 / $59.85 / $69.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $60.68