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Idaho 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
$16.57 / $17.61 / $20.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.61 / $18.89 / $25.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $1.10 / $413.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72