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Georgia rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $85.11 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $70.79 / $134.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $2,238.72 / $3,548.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $97.72 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $97.72 / $173.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $74.13 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $1,513.56 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $83.18 / $144.54