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Diaphragm Or Cervical Cap Fitting And Insertion

Minnesota rates for HCPCS 57170

This is the fitting and insertion of a diaphragm or cervical cap, barrier methods of birth control that are placed inside the vagina before intercourse to prevent pregnancy. A clinician determines the correct size, inserts the device to confirm proper fit, and provides instructions on how to use, insert, and remove it correctly. It's a one-time office visit for fitting, separate from any device purchased afterward.

Facilitymedian $355 · 10th–90th $72$1,2590%5%10th90th$355Professionalmedian $120 · 10th–90th $55$2690%5%10th90th$120$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$69.18
Typical High
$112.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$478.63
Typical High
$1,479.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$141.25
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$288.40
Typical High
$676.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$323.59
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$269.15
Typical High
$524.81
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$169.82
Typical High
$302.00
Medica
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$123.03
Typical High
$1,737.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$151.36
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$1,819.70
Typical High
$3,715.35
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$123.03
Typical High
$251.19