go back

Mississippi 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
$16.98 / $24.86 / $24.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $17.61 / $24.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $20.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.89 / $20.72 / $26.94