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Indiana rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.60 / $71.62 / $85.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.60 / $57.41 / $85.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.00 / $4,320.00 / $8,230.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.98 / $89.02 / $156.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.23 / $55.09 / $95.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.22 / $83.06 / $103.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.18 / $54.18 / $54.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.16 / $85.07 / $166.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.34 / $91.48 / $134.22