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South Dakota rates for HCPCS V5264

Ear mold/insert, not disposable, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.45 / $68.54 / $178.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.13 / $61.13 / $76.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.45 / $68.54 / $119.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.36 / $63.36 / $63.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $48.00 / $48.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.30 / $48.30 / $48.30