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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
$48.98 / $83.18 / $158.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $79.43 / $123.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $104.71 / $141.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $104.71 / $141.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $75.86 / $123.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $95.50 / $165.96