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South Carolina rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $85.11 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $66.07 / $112.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $33.11 / $60.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $69.18 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $81.28 / $131.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $83.18 / $144.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $69.18 / $131.83