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South Dakota 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 / $54.95 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $79.43 / $234.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $54.95 / $61.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $64.57 / $66.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $54.95 / $63.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $60.26