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South Dakota rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $20.72 / $20.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $22.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.71 / $27.90 / $51.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $22.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $26.11