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Rhode Island 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
$179.27 / $179.27 / $179.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.71 / $57.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $55.16 / $58.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $55.16