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Tennessee rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.70 / $63.95 / $191.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $63.95 / $110.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.00 / $1,364.00 / $2,065.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.99 / $73.52 / $120.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.14 / $83.93 / $139.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $226.86 / $226.86
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.04 / $553.87 / $652.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $808.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.61 / $103.77 / $156.60