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Pennsylvania 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
$18.89 / $94.17 / $122.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $93.64 / $103.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.78 / $93.28 / $93.28
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.41 / $100.05 / $155.40
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.62 / $214.62 / $214.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.36 / $144.46 / $198.14
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.58 / $88.00 / $89.90
Johns Hopkins Employer Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.22 / $106.22 / $106.22
Johns Hopkins Employer Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.22 / $106.22 / $106.22
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.89 / $94.17 / $122.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $94.45 / $118.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.95 / $145.79 / $243.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.16 / $109.16 / $109.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $86.90 / $86.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.23 / $97.09 / $166.44