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Massachusetts 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 / $96.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.19
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.50 / $147.83 / $236.62
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.13 / $55.16 / $63.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.13 / $67.73 / $150.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $55.16 / $68.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.26 / $87.15 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $110.32
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $236.62 / $236.62
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $73.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $67.88