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Washington 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 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $2.69 / $7.08
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $34.67 / $34.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $74.13 / $79.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61