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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$189.97 / $189.97 / $227.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.58 / $189.97 / $225.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.98 / $375.00 / $375.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.08 / $306.08 / $306.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $160.94 / $160.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.22 / $257.22 / $390.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.39 / $144.59 / $192.78
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00