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Montana rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $16.98 / $19.95
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $537.03 / $537.03
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $537.03 / $537.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89