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Louisiana 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 / $57.54 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $60.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $56.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $21.38 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $54.95 / $58.88