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Minnesota rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.11 / $72.30 / $72.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.11 / $70.48 / $94.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.98 / $445.70 / $877.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.62 / $157.13 / $274.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.19 / $271.14 / $652.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.90 / $190.92 / $324.12
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.43 / $247.88 / $513.59
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.03 / $162.96 / $302.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.42 / $122.19 / $563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.84 / $194.76 / $374.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.00 / $1,749.00 / $2,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.42 / $164.70 / $282.58