Custom ear mold insert

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Earmold Standard

Payers reporting HCPCS V5264

Payer pricing summary

Low

Average

$92

Median

$74

High

$397

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Premera other · outpatient · +2 other terms	1	$40	$40	—	—	4–40	$40 – $40
2	Kaiser percent of total billed charges · outpatientfrom % of charges · +5 other terms	8	$126	$124	$82	66%	3–30	$22 – $300
3	Superior Healthplan other · outpatient · +1 other terms	1	$17	$17	—	—	3–30	$17 – $17
4	UnitedHealthcare fee schedule · outpatient · +22 other terms	36	$60	$61	$25	41%	2–20	$1 – $108
5	Aetna fee schedule · outpatient · +18 other terms	36	$68	$127	$123	97%	—	$23 – $444
6	Blue Cross Blue Shield facility · fee schedule · outpatient · +18 other terms	27	$32	$42	$26	63%	—	$12 – $175
7	Molina facility · case rate · outpatient · +14 other terms	18	$35	$56	$34	62%	—	$15 – $125
8	Medcost percent of total billed charges · bothfrom % of charges · +4 other terms	17	$8	$13	$11	86%	—	$8 – $36
9	Oscar professional · percent of total billed charges · outpatientfrom % of charges · +6 other terms	17	$107	$99	$33	33%	—	$22 – $190
10	Anthem facility · case rate · outpatient · +14 other terms	15	$33	$36	$8	23%	—	$23 – $56
11	Caresource facility · case rate · outpatient · +11 other terms	15	$34	$36	$8	23%	—	$23 – $57
12	Cigna fee schedule · outpatient · +16 other terms	14	$20	$44	$42	94%	—	$19 – $158
13	Sanford Health Plan professional · percent of total billed charges · outpatientfrom % of charges · +3 other terms	14	$107	$112	$28	25%	—	$95 – $194
14	Beechstreet percent of total billed charges · bothfrom % of charges · +2 other terms	13	$14	$61	$96	156%	—	$11 – $338
15	Wellmark fee schedule · both · +8 other terms	13	$48	$52	$23	44%	—	$48 – $190
16	Baylor Scott White Health Plan facility · percent of total billed charges · outpatientfrom % of charges	12	$41	$36	$9	26%	—	$13 – $45
17	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$56	$55	$18	32%	—	$29 – $70
18	Medica fee schedule · outpatient · +12 other terms	12	$95	$96	$27	28%	—	$48 – $126
19	Cigna Healthspring percent of total billed charges · bothfrom % of charges	11	$7	$7	—	—	—	$7 – $7
20	Optum facility · case rate · outpatient · +11 other terms	11	$31	$34	$7	22%	—	$28 – $51
21	Highmark fee schedule · outpatient · +8 other terms	10	$110	$110	—	—	—	$110 – $110
22	Ucare fee schedule · both · +9 other terms	10	$49	$50	$7	15%	—	$46 – $90
23	Aetna Better Health facility · fee schedule · outpatient · +10 other terms	8	$69	$71	$8	12%	—	$53 – $96
24	Bcbs Il professional · fee schedule · both	8	$48	$58	$87	151%	—	$0 – $190
25	First Health professional · fee schedule · both · +14 other terms	8	$0	$24	$31	129%	—	$0 – $63

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