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South Dakota 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 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $83.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $95.50 / $181.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $72.44 / $72.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $79.43
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10