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South Dakota 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 / $55.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $55.16 / $68.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $93.22 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.89 / $55.16 / $61.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.11 / $64.31 / $66.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.71 / $60.20 / $80.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.07 / $60.37 / $60.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $60.68
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $60.36