go back

Maine rates for HCPCS G0245

Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot, and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (4) patient education

Facilitymedian $40 · 10th–90th $40–$620%20%40%90th$40Professionalmedian $58 · 10th–90th $36–$1170%10%10th90th$58$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $66.07 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $81.28 / $165.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $52.48 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $81.28 / $134.90