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Massachusetts rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $67.61 / $204.17
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $501.19 / $2,818.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $100.00 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $123.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $144.54 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $109.65 / $218.78
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $87.10 / $186.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $562.34 / $2,818.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,819.70 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $102.33 / $194.98