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Utah 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
$63.99 / $63.99 / $117.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.99 / $63.99 / $125.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $70.78 / $81.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.22 / $53.59 / $71.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.40 / $55.16 / $55.16