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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
$67.15 / $67.15 / $73.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.34 / $27.34 / $48.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.34 / $74.02 / $74.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.34 / $27.34 / $48.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.47 / $25.34 / $74.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.68 / $74.68 / $79.31