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Alaska rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.51 / $142.51 / $221.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.49 / $229.76 / $356.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.20 / $165.20 / $229.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.46 / $321.66 / $499.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.79 / $298.20 / $511.01
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.35 / $290.00 / $388.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.46 / $321.66 / $499.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.73 / $248.40 / $388.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.38 / $275.70 / $366.57