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Wisconsin rates for HCPCS J7639

Dornase alfa, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per mg

Facilitymedian $69 · 10th–90th $55–$1660%20%10th90th$69Professionalmedian $55 · 10th–90th $55–$930%50%90th$55$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $83.18 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $93.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $69.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $131.83 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $102.33
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $54.95 / $60.26
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $109.65 / $109.65
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $56.23 / $234.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $54.95 / $72.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $56.23 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $72.44 / $165.96
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $85.11 / $234.42
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $50.12 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $54.95 / $66.07