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North Dakota rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $16.57 / $37.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $20.72 / $20.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $22.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $20.72 / $28.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $22.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $20.72 / $27.35