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Utah 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
$69.13 / $69.13 / $69.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.12 / $87.10 / $170.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.93 / $20.93 / $20.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00