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South Dakota rates for HCPCS 90586

Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.97 / $162.97 / $162.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.16 / $162.97 / $188.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.94 / $199.92 / $199.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.50 / $223.31 / $427.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.97 / $179.56 / $179.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.41 / $187.39 / $201.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.61 / $172.00 / $224.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.35 / $178.35 / $178.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.28 / $179.28 / $184.17
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.16 / $156.16 / $156.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.16 / $156.16 / $156.16