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South Carolina rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.86 / $85.76 / $161.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $75.04 / $112.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.61 / $36.61 / $60.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.00 / $70.58 / $117.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.44 / $51.44 / $66.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.02 / $83.93 / $144.37
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.86 / $85.76 / $137.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $45.51 / $70.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.90 / $75.30 / $118.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.27 / $94.64 / $168.04