| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.20 | $17.20 | $17.20 | |
United
| Professional | $20.72 | $20.72 | $20.72 |
Injection Chloroquine Hydrochloride Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.20 | $17.20 | $17.20 | |
United
| Professional | $20.72 | $20.72 | $20.72 |