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New Mexico 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 / $85.99 / $85.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $70.06 / $125.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.08 / $50.08 / $65.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $54.58 / $55.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $53.59 / $80.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.25 / $55.16 / $57.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $54.58 / $55.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.59 / $53.59 / $53.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16