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Utah 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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $223.87 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $204.17 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $162.18 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $194.98 / $194.98