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Wyoming 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 / $55.16 / $55.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.58 / $64.20 / $64.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.04 / $52.04 / $52.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $78.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $55.16