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Louisiana rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.17 / $62.87 / $88.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.44 / $72.77 / $88.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $173.82 / $399.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.05 / $86.41 / $119.21
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $81.86 / $129.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $89.25 / $151.21