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Nebraska 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
$54.95 / $85.11 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $58.88 / $63.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $63.10
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 / $56.23 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $60.26 / $234.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $53.70 / $57.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $66.07 / $83.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $21.38 / $54.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $53.70 / $56.23