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Oregon 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 / $64.79 / $110.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.71 / $125.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $75.84 / $107.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $59.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.37 / $119.37 / $141.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.19 / $55.16 / $78.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $58.47 / $71.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.15 / $68.95 / $165.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.25 / $65.31 / $107.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.74 / $65.31 / $66.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $63.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $63.43