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Utah rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $67.61 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $79.43 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $93.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $331.13 / $758.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $102.33 / $128.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $81.28 / $144.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $102.33 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $70.79 / $120.23