Contraceptive cervical cap

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Diaphragm or cervical cap fitting w/instructions 57170

Payers reporting HCPCS A4261

Payer pricing summary

Low

Average

$1.1k

Median

$41

High

$13.8k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +9 other terms	38	$41	$72	$63	88%	—	$27 – $224
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +7 other terms	30	$75	$78	$36	46%	—	$30 – $202
3	Anthem facility · case rate · outpatient · +4 other terms	15	$10	$11	$3	23%	—	$7 – $17
4	Caresource facility · case rate · outpatient · +2 other terms	15	$10	$11	$3	23%	—	$7 – $17
5	Molina facility · case rate · outpatient · +6 other terms	15	$10	$11	$3	23%	—	$7 – $17
6	UnitedHealthcare facility · case rate · outpatient · +11 other terms	15	$10	$11	$3	23%	—	$7 – $17
7	Wellmark fee schedule · both	13	$19	$19	—	—	—	$19 – $19
8	Cigna facility · fee schedule · outpatient · +6 other terms	12	$33	$20	$11	57%	—	$7 – $33
9	Optum facility · case rate · outpatient · +1 other terms	11	$10	$10	$2	22%	—	$9 – $15
10	Highmark fee schedule · outpatient · +2 other terms	10	$24	$24	$1	5%	—	$24 – $28
11	Medica fee schedule · both · +1 other terms	9	$60	$60	—	—	—	$60 – $60
12	Ucare fee schedule · both · +3 other terms	9	$61	$62	$3	5%	—	$58 – $65
13	Bcbs Mn fee schedule · both · +1 other terms	8	$65	$65	—	—	—	$65 – $65
14	Aetna Better Health fee schedule · inpatient · +3 other terms	7	$27	$27	—	—	—	$27 – $27
15	Humana fee schedule · inpatient · +4 other terms	5	$27	$27	—	—	—	$27 – $27
16	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$86	$89	$5	6%	—	$85 – $96
17	Bcbs Tx facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	3	$8.2k	$12.6k	$6.7k	53%	—	$5.9k – $23.1k
18	First Health professional · fee schedule · both · +1 other terms	3	$29	$29	—	—	—	$29 – $29
19	Tricare facility · fee schedule · outpatient · +1 other terms	2	$48	$48	—	—	—	$48 – $48
20	Amerihealth Caritas fee schedule · outpatient	1	$66	$66	—	—	—	$66 – $66
21	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
22	Bcbs Nc facility · fee schedule · outpatient	1	$51	$51	—	—	—	$51 – $51
23	Bcbs Nv fee schedule · outpatient · +1 other terms	1	$7	$7	—	—	—	$7 – $7
24	Bcbs Vt professional · fee schedule · outpatient	1	$33	$33	—	—	—	$33 – $33
25	Kaiser facility · fee schedule · both	1	$4	$4	—	—	—	$4 – $4

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