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Montana rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.49 / $73.27 / $298.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.14 / $74.14 / $123.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.14 / $74.14 / $74.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.14 / $80.31 / $123.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.82 / $116.35 / $120.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.07 / $82.02 / $126.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.59 / $117.16 / $218.29