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Montana 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
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $74.13 / $74.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $30.20 / $34.67
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $30.20 / $34.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $48.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $60.26 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $79.43