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Wisconsin rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $16.60 / $16.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $16.60 / $23.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $17.78 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $43.65 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $20.42 / $22.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $16.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $16.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $26.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.18