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Pennsylvania 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
$67.61 / $67.61 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $74.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $75.86 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
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
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $112.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $81.28
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $39.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $39.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $79.43 / $97.72