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Idaho 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 / $55.16 / $55.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $60.68 / $68.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $54.58 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $61.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $57.92 / $73.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $68.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.43 / $39.54 / $53.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.56 / $65.56 / $65.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $68.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.52 / $55.16 / $55.16