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Utah rates for HCPCS V5264

Ear mold/insert, not disposable, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.22 / $57.45 / $68.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $14.25 / $14.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $49.40 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.50 / $43.50 / $43.50