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Diaphragm Or Cervical Cap Fitting And Insertion

South Dakota rates for HCPCS 57170

This is the fitting and insertion of a diaphragm or cervical cap, barrier methods of birth control that are placed inside the vagina before intercourse to prevent pregnancy. A clinician determines the correct size, inserts the device to confirm proper fit, and provides instructions on how to use, insert, and remove it correctly. It's a one-time office visit for fitting, separate from any device purchased afterward.

Facilitymedian $72 · 10th–90th $42$1550%20%10th90th$72Professionalmedian $72 · 10th–90th $42$1510%10%10th90th$72$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$46.77
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$61.66
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$131.83
Typical High
$223.87
Medica
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$102.33
Typical High
$169.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$120.23
Typical High
$575.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$165.96
Midlands
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$144.54
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$102.33
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
United
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$102.33
Typical High
$177.83
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$177.83