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Maine 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
$92.00 / $92.00 / $92.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $92.03 / $130.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.16 / $97.55 / $185.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.16 / $109.16 / $109.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $86.90 / $86.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.37 / $139.26 / $249.08
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.03 / $96.87 / $110.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $95.71 / $156.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.52 / $126.22 / $197.01