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New Hampshire rates for HCPCS G0470

Federally Qualified Health Center (FQHC) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.51 / $102.51 / $102.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.12 / $102.51 / $112.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $308.62 / $377.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $3,000.00 / $4,410.00