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Utah rates for HCPCS 57170

Diaphragm or cervical cap fitting with instructions

Facilitymedian $83 · 10th–90th $62–$7080%20%10th90th$83Professionalmedian $72 · 10th–90th $43–$1350%10%10th90th$72$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $70.79 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $79.43 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $93.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $398.11 / $602.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $102.33 / $125.89
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $87.10 / $125.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $102.33 / $128.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $70.79 / $120.23