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South Carolina rates for HCPCS J0390

Injection Chloroquine Hydrochloride Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $68.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $17.61 / $17.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.59 / $6.32 / $6.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $5.88 / $5.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $19.91 / $32.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.14 / $289.14 / $289.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72