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Oklahoma 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 / $59.57 / $101.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.71 / $59.57 / $59.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $42.58 / $67.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $52.04 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $55.16 / $55.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.63 / $57.91 / $236.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.61 / $55.16 / $55.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.42 / $88.42 / $88.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.19 / $55.16 / $55.16