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South Carolina rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $61.66 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $16.98 / $23.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $6.31 / $6.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $20.42 / $33.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $22.91