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New Hampshire rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $19.50 / $22.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $16.98 / $17.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $17.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $28.84 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $50.12