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Texas rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.51 / $74.20 / $94.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.51 / $68.02 / $91.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.72 / $72.15 / $113.16
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.78 / $40.78 / $40.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.03 / $58.03 / $58.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.14 / $82.10 / $136.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $226.86
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.04 / $553.87 / $652.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.87 / $78.79 / $141.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.71 / $85.43 / $131.32
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.70 / $113.70 / $113.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.89 / $79.22 / $144.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.99 / $84.30 / $141.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $950.00 / $2,376.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.33 / $74.08 / $123.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.04 / $72.48 / $101.26