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Wisconsin rates for HCPCS 57170

Diaphragm/Cervical Cap Fitting W/Instructions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.50 / $94.46 / $280.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.72 / $67.42 / $206.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.05 / $161.30 / $352.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.55 / $239.04 / $385.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.97 / $152.28 / $261.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.18 / $83.81 / $150.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.38 / $96.68 / $1,778.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.86 / $196.93 / $372.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.20 / $85.00 / $163.35
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.98 / $77.54 / $150.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.30 / $167.89 / $260.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.95 / $214.95 / $214.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.22 / $327.24 / $576.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.38 / $115.38 / $195.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.74 / $249.08 / $420.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.06 / $165.04 / $292.06