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Arizona rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.17 / $41.44 / $62.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.78 / $16.78 / $20.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.27 / $17.27 / $17.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.78 / $24.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72