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Montana 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
Professional
Modifier
Low / Median / High Price
$60.13 / $66.73 / $125.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.68 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.17 / $61.17 / $141.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $61.17 / $61.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.79 / $61.17 / $141.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.85 / $59.85 / $70.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16