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Indiana 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
$55.71 / $128.35 / $250.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.71 / $57.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.92 / $110.32 / $165.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.88 / $55.16 / $76.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $75.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $55.16 / $147.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.42 / $88.42 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $57.79