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Rhode Island rates for HCPCS J7639

Dornase alfa, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $56.23 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $58.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $54.95 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $54.95 / $54.95