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North Carolina 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
$34.79 / $54.58 / $92.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.08 / $50.08 / $66.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.30 / $95.16 / $121.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.46 / $55.16 / $64.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $55.16 / $64.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.08 / $57.79 / $65.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $57.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.38 / $65.38 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $60.12
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $236.62 / $236.62