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South Dakota 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
$178.84 / $178.84 / $178.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.84 / $178.84 / $191.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $294.49 / $294.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.54 / $323.30 / $387.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.49 / $240.98 / $1,409.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.70 / $362.83 / $630.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.70 / $301.85 / $362.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.50 / $144.59 / $265.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.20 / $275.20 / $275.20