go back

Indiana rates for HCPCS G2025

Payment for a telehealth distant site service furnished by a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.03 / $92.39 / $92.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $92.39 / $103.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.91 / $89.30 / $89.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.23 / $51.87 / $82.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.30 / $111.63 / $133.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.30 / $107.16 / $133.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.16 / $109.16 / $109.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $86.90 / $86.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.73 / $95.33 / $136.82