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Nebraska rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $39.83 / $45.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $16.57 / $27.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.66 / $19.55 / $19.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.57 / $19.35 / $19.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $22.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $31.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.68 / $20.72 / $20.72