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Maine 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
$127.97 / $127.97 / $137.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.37 / $57.37 / $66.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.55 / $170.55 / $170.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $55.16 / $64.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.97 / $127.97 / $137.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $57.91 / $92.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $79.98