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Maine rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.24 / $69.37 / $71.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.01 / $80.98 / $117.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.09 / $101.62 / $148.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.53 / $95.63 / $148.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.24 / $67.42 / $73.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.45 / $92.66 / $156.44