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Utah rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.20 / $17.20 / $17.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $17.20 / $17.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $267.62 / $338.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.68 / $20.72 / $20.72