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Maryland 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 / $17.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $17.61 / $22.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $17.61 / $17.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $21.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $17.27 / $17.27