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
$7
Average
$1.5k
Median
$16
High
$19.6k
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 7.4× 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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27 hospital rates
iThe hospitals that file a Cigna 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 | Blue Hill Memorial Hospital Hill, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 2 | Charles A. Dean Memorial Hospital Greenville, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 3 | $8 | $8 | $0 | 4% | — | $7 – $8 |
| 4 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 5 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 6 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $19.6k | $19.6k | — | — | — | $19.6k – $19.6k |
| 7 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $19.6k | $19.6k | — | — | — | $19.6k – $19.6k |
| 8 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · fee schedule · outpatient | 3 | $11 | $10 | $1 | 10% | — | $9 – $11 |
| 9 | MARTIN MEMORIAL MEDICAL CENTER INC Port St Lucie, FL facility · fee schedule · outpatient | 3 | $9 | $10 | $2 | 23% | — | $7 – $13 |
| 10 | Maine Coast Regional Health Facilities Ellsworth, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 11 | MaineHealth Rockport, ME percent of total billed charges · bothfrom % of charges | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 12 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $8 | $8 | — | — | — | $8 – $8 |
| 13 | Mayo Regional Hospital Dover Foxcroft, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 14 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 15 | Mercy Hospital Portland, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 16 | MultiCare Auburn Medical Center Auburn, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 17 | MultiCare Capital Medical Center Lacey, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 18 | MultiCare Covington Medical Center Covington, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 19 | MultiCare Deaconess Hospital Spokane, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 20 | MultiCare Valley Hospital Spokane Valley, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 21 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · both | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 22 | Sebasticook Valley Health Pittsfield, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 23 | Tacoma General Allenmore Hospital Bremerton, WA fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 24 | The Aroostook Medical Center Isle, ME facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 25 | The University of Texas Medical Branch Webster, TX percent of total billed charges · bothfrom % of charges | 1 | $61 | $61 | — | — | — | $61 – $61 |
← Payers reporting HCPCS A4261 · Snapshot 20261112T181611Z-3fa9fb76