Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC Diaphragm/Cervical Cap Fitting W/Instructions
Prices here combine facility and professional fees. See them separately →Experimental
Low
$0
Average
$636
Median
$221
High
$8.1k
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 175 hospitals; the 90th percentile is 12.9× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Boston Medical Center Boston, MA | $235 | $286 | $111 | 39% | 4–40 | $227 – $577 |
| 2 | Samaritan Medical Center Watertown, NY | $200 | $200 | — | — | 2–20 | $200 – $200 |
| 3 | St Luke's Regional Medical Center, LTD Boise, ID | $218 | $222 | $6 | 3% | 1–10 | $218 – $240 |
| 4 | Northern Itasca Hospital District Bigfork, MN | $62 | $62 | — | — | — | $62 – $62 |
| 5 | San Joaquin Community Hospital Bakersfield, CA | $260 | $260 | — | — | — | $260 – $260 |
| 6 | Columbia St. Mary's Hospital Ozaukee, Inc. Mequon, WI | $196 | $274 | $111 | 40% | — | $196 – $431 |
| 7 | Henry Ford Health Novi, MI | $197 | $175 | $55 | 31% | — | $74 – $272 |
| 8 | Northside Hospital, Inc. Lawrenceville, GA | $9.0k | $7.5k | $3.5k | 47% | — | $40 – $12k |
| 9 | Gundersen Luthern Medical Center Inc La Crosse, WI | $97 | $97 | — | — | — | $97 – $97 |
| 10 | City Hospital, Inc. Martinsburg, WV | $206 | $232 | $47 | 20% | — | $195 – $341 |
Ask Claude or any MCP client for CPT 57170 pricing at a specific hospital — see how to connect.