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Illinois 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
$16.57 / $33.57 / $55.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $16.57 / $17.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.20 / $61.38 / $258.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.63 / $46.63 / $46.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.65 / $51.15 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $3.58 / $3.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $21.34