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West Virginia 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
$55.44 / $55.44 / $55.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.71 / $57.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.13 / $55.16 / $82.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.85 / $38.61 / $55.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $54.58 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.99 / $55.16 / $100.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $79.89