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Utah rates for HCPCS A4238

Supply Allowance For Adjunctive Non-Implanted Continuous Glucose Monitor (Cgm) Includes All Supplies And Accessories 1 Month Supply = 1 Unit Of Service (Desc Rvsd 1/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.41 / $133.41 / $133.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.41 / $180.22 / $362.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $160.94 / $160.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.50 / $144.59 / $240.98