| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.68 | $19.68 | $19.68 | |
Aetna
| Professional | $17.20 | $17.20 | $19.68 | |
Providence
| Facility | $20.72 | $20.72 | $21.81 | |
United
| Professional | $20.72 | $20.72 | $20.72 |
Injection, chloroquine HCl, up to 250 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.68 | $19.68 | $19.68 | |
Aetna
| Professional | $17.20 | $17.20 | $19.68 | |
Providence
| Facility | $20.72 | $20.72 | $21.81 | |
United
| Professional | $20.72 | $20.72 | $20.72 |