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Maine rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.07 / $48.07 / $51.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $17.61 / $17.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.78 / $17.27 / $17.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $17.27 / $20.91
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.07 / $48.07 / $51.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $17.61 / $51.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $36.26