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Utah rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.74 / $62.74 / $83.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.49 / $73.27 / $92.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.04 / $80.34 / $126.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.18 / $57.64 / $72.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.83 / $377.82 / $550.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.17 / $101.83 / $117.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.05 / $75.97 / $145.44