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Hawaii rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.72 / $62.04 / $69.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.79 / $76.70 / $98.50
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.34 / $90.86 / $104.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.89 / $86.68 / $110.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,078.00 / $1,078.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.38 / $98.50 / $114.78
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.58 / $62.13 / $110.21