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
Diaphragm or cervical cap fitting w/instructions 57170
Low
$0
Average
$75
Median
$55
High
$400
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 4.3× 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.
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62 hospital rates
iThe hospitals that file a Blue Cross Blue Shield rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Adventhealth Ottawa Ottawa, KS fee schedule · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 2 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 4 | $1 | $1 | $0 | 43% | — | $0 – $1 |
| 3 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 4 | Blessing Hospital Quincy, IL professional · fee schedule · both | 1 | $25 | $23 | $3 | 13% | — | $19 – $25 |
| 5 | Bronson Battle Creek Hospital Battle Creek, MI professional · percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 6 | Bronson LakeView Hospital Paw Paw, MI professional · percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 7 | Bronson Methodist Hospital Kalamazoo, MI professional · percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 8 | Bronson South Haven Hospital South Haven, MI professional · percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 9 | Corewell Health Farmington Hills Hospital Farmington Hills, MI facility · fee schedule · outpatient | 2 | $100 | $100 | — | — | — | $100 – $100 |
| 10 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 11 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 12 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 13 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 14 | Duncan Regional Hospital Duncan, OK case rate · outpatient | 5 | $400 | $400 | — | — | — | $400 – $400 |
| 15 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 16 | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE PAUL, MN professional · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 17 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 2 | $51 | $51 | — | — | — | $51 – $51 |
| 18 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 3 | $47 | $45 | $2 | 4% | — | $42 – $47 |
| 19 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 3 | $59 | $53 | $8 | 14% | — | $42 – $59 |
| 20 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 3 | $44 | $43 | $0 | 1% | — | $42 – $44 |
| 21 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 3 | $47 | $46 | $2 | 5% | — | $42 – $47 |
| 22 | HonorHealth Florence Medical Center Florence, AZ facility · fee schedule · outpatient | 1 | $74 | $75 | $22 | 29% | — | $53 – $97 |
| 23 | Honorhealth Deer Valley Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $75 | $75 | $22 | 30% | — | $53 – $97 |
| 24 | Honorhealth Four Peaks Medical Center Mesa, AZ facility · fee schedule · outpatient | 1 | $74 | $75 | $22 | 29% | — | $53 – $97 |
| 25 | Honorhealth John C. Lincoln Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $75 | $75 | $22 | 30% | — | $53 – $97 |
← Payers reporting HCPCS A4261 · Snapshot 20261112T181611Z-3fa9fb76