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New Hampshire rates for HCPCS 90586

Bacillus Calmette-Guerin Vaccine Intravesical

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.16 / $174.90 / $326.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.97 / $162.97 / $162.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.84 / $244.47 / $670.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.28 / $173.28 / $173.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.75 / $203.81 / $203.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.81 / $203.81 / $203.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.00 / $264.68 / $503.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.97 / $162.97 / $218.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.21 / $176.23 / $224.29