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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
$47.86 / $47.86 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $67.61 / $91.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $72.44 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $77.62 / $100.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $102.33 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $87.10 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $616.60 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $63.10 / $93.33