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Washington rates for HCPCS V5264

Ear mold/insert, not disposable, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.28 / $57.45 / $68.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $10,000.00 / $10,000.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $100.00 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $14.25 / $14.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.86 / $65.69 / $97.17
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00