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Nebraska rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.22 / $43.22 / $71.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.22 / $71.98 / $248.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,608.94 / $2,180.53 / $4,093.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.24 / $87.40 / $145.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.84 / $145.31 / $188.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.11 / $117.82 / $297.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.50 / $162.61 / $576.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.45 / $143.62 / $189.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $143.62 / $189.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $102.70 / $205.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.49 / $154.47 / $185.95