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Montana rates for HCPCS V5264

Ear mold/insert, not disposable, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.45 / $57.45 / $62.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $14.25 / $14.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.02 / $45.02 / $45.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $175.00 / $10,000.00