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South Dakota rates for HCPCS G0467

Federally Qualified Health Center (FQHC) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.10 / $96.10 / $96.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.12 / $96.10 / $205.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.93 / $20.93 / $20.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.73 / $162.41 / $197.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.52 / $140.52 / $140.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.00 / $74.00 / $74.00