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Arizona 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
$59.02 / $110.32 / $165.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.91 / $60.68 / $125.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.69 / $183.31 / $290.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $52.95 / $120.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.66 / $57.91 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $55.16 / $55.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.42 / $88.42 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16