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Illinois rates for HCPCS 90702

Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $67.61 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $645.65 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $35.48 / $70.79
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $28.18 / $30.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $79.43 / $79.43