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Utah 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 / $92.03 / $98.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.69 / $92.74 / $99.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $86.90 / $86.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.31 / $112.40 / $132.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.59 / $99.45 / $153.87