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Utah 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 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $741.31 / $741.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $77.62 / $79.43