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Virginia 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
$67.16 / $67.16 / $164.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.16 / $67.16 / $73.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.41 / $67.41 / $67.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.02 / $74.02 / $74.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.50 / $74.02 / $74.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.06 / $24.49 / $25.06
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.26 / $79.01 / $102.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $41.00 / $41.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.81 / $75.06 / $97.28
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.81 / $75.06 / $97.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.09 / $79.01 / $79.31