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Diaphragm Or Cervical Cap Fitting And Insertion

Nebraska 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 $214 · 10th–90th $72$2,8180%5%10%10th90th$214Professionalmedian $91 · 10th–90th $43$2450%10%10th90th$91$5.0$20.0$100.0$500.0$2.0K

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
$70.79
Median
$83.18
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$91.20
Typical High
$245.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$2,089.30
Typical High
$4,073.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$83.18
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$120.23
Typical High
$186.21
Medica
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$123.03
Typical High
$1,230.27
Medica
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$575.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$147.91
Typical High
$186.21
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$169.82
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$112.20
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$1,047.13
Typical High
$3,801.89
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$102.33
Typical High
$169.82