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Washington 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
$243.45 / $509.55 / $552.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.79 / $215.00 / $371.95
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.95 / $527.58 / $1,453.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.81 / $1,409.81 / $2,389.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $160.94 / $160.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.21 / $900.21 / $900.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $75.00 / $285.28
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.44 / $499.46 / $550.07
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.44 / $327.44 / $327.44
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.95 / $261.95 / $261.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.59 / $165.13 / $261.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $375.00 / $375.00