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South Dakota rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $46.77 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $67.61 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $131.83 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $100.00 / $169.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $120.23 / $575.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $165.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $144.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $102.33 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $104.71 / $177.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $109.65 / $177.83