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Michigan rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.41 / $59.80 / $95.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.57 / $66.89 / $95.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.73 / $51.23 / $70.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.44 / $49.16 / $95.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.74 / $72.76 / $119.07
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.41 / $64.39 / $91.86
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.80 / $71.59 / $101.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.90 / $68.34 / $97.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $1,428.00 / $2,029.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.93 / $89.94 / $116.84