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Washington, DC 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
$55.16 / $155.55 / $209.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.15 / $83.18 / $140.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $52.04 / $55.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.85 / $46.89 / $55.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $55.16 / $55.16