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Nebraska rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $83.18 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $83.18 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,089.30 / $4,073.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $83.18 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $104.71 / $186.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $123.03 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $131.83 / $575.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $147.91 / $186.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $169.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $112.20 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $1,230.27 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $104.71 / $169.82