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New Hampshire rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $67.61 / $138.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $83.18 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $112.20 / $194.98
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $89.13 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $100.00 / $181.97