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Rhode Island rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.34 / $67.34 / $67.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $16.57 / $17.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.66 / $358.56 / $429.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72