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Connecticut 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
$57.54 / $91.20 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $63.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $87.10 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $60.26 / $69.18
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 / $60.26