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Washington 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
$58.00 / $93.18 / $114.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $60.68 / $82.76
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.74 / $85.05 / $236.62
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $55.16 / $64.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $52.04 / $107.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $55.16 / $67.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.13 / $58.82 / $58.82
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.15 / $62.45 / $165.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.74 / $51.74 / $56.63
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.74 / $58.14 / $98.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $65.56
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
$22.06 / $55.16 / $55.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16