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Arkansas rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.15 / $69.17 / $108.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.49 / $59.43 / $85.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.16 / $181.16 / $217.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.23 / $69.45 / $102.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.32 / $13.32 / $13.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $89.77 / $120.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $88.65 / $139.87