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Illinois 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 / $67.42 / $143.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $108.01 / $620.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $55.16 / $55.16
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $84.84 / $125.43
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.70 / $71.70 / $71.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.38 / $88.42 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.94 / $55.16 / $58.52