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Arkansas rates for HCPCS J0390

Injection Chloroquine Hydrochloride Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.61 / $17.61 / $17.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $17.20 / $17.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.08 / $3.08 / $3.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $3.08 / $3.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.92 / $17.92 / $17.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.64 / $20.72 / $20.72