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Missouri 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
$55.16 / $64.20 / $1,911.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $56.82 / $66.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.12 / $93.77 / $145.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $68.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $54.58 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.26 / $60.10 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $62.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.76 / $71.76 / $96.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $62.93