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Pennsylvania rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Facilitymedian $30 · 10th–90th $17–$490%10%20%10th90th$30Professionalmedian $17 · 10th–90th $16–$180%50%10th90th$17$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $29.51 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $16.98 / $17.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $17.38 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $17.38 / $17.38
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $26.30 / $28.18
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $16.98 / $16.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $18.20 / $18.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $18.20 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $28.84