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Nebraska 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 / $79.98 / $121.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $125.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.84 / $62.45 / $62.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.20 / $61.82 / $62.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $54.58 / $54.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $68.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $60.53 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $57.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.13 / $64.31 / $67.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.52 / $61.70 / $121.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.81 / $56.81 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $56.50