| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.61 | $17.61 | $29.55 | |
United
| Professional | $17.61 | $20.72 | $21.55 |
Injection Chloroquine Hydrochloride Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.61 | $17.61 | $29.55 | |
United
| Professional | $17.61 | $20.72 | $21.55 |