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Arizona rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.30 / $67.42 / $271.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.56 / $32.02 / $52.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.73 / $66.09 / $99.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.48 / $74.48 / $74.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $72.27 / $120.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.43 / $80.61 / $1,126.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.22 / $87.78 / $576.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.38 / $73.34 / $145.80