go back

Oklahoma rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.78 / $16.78 / $33.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.78 / $16.78 / $16.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.78 / $18.46 / $24.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72