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Minnesota 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 / $110.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $69.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.52 / $66.19 / $101.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.13 / $53.59 / $55.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.85 / $173.55 / $211.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.15 / $63.93 / $69.34
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.99 / $153.44 / $198.77
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $54.60 / $58.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.70 / $55.16 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $55.16 / $76.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $76.13