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Missouri rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $19.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $46.77 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $20.89 / $21.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $8.32 / $20.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $20.89 / $23.44