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Oklahoma rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.71 / $48.71 / $79.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $52.49 / $79.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.90 / $71.34 / $99.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.73 / $79.04 / $99.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.15 / $84.89 / $1,470.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $104.22 / $576.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $610.00 / $1,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.32 / $80.19 / $126.48