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New Mexico rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.68 / $19.68 / $19.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $17.20 / $19.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $21.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72