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Montana rates for HCPCS A4238

Supply allowance for adjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.41 / $155.36 / $256.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $160.94 / $160.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.95 / $275.20 / $275.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $322.51 / $1,800,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.59 / $144.59 / $157.16