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Tennessee 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 / $89.91 / $120.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $66.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.15 / $59.83 / $62.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.16 / $55.16 / $55.16
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.20 / $236.62 / $236.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.59 / $88.42 / $115.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $55.16 / $55.16