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North Carolina rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $18.62 / $23.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $16.98 / $19.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $18.62 / $20.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $26.92
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36