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Massachusetts rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.61 / $17.61 / $41.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $17.61 / $17.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $9.27 / $165.22
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $18.64 / $25.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.53 / $22.04 / $46.97
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $17.27 / $36.61
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $20.72 / $31.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $20.72 / $36.26