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North Carolina 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 $63 · 10th–90th $40–$1070%20%10th90th$63Professionalmedian $74 · 10th–90th $40–$1350%10%20%10th90th$74$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $51.29 / $75.86
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $85.11 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $67.61
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $91.20 / $91.20
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $63.10 / $104.71
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $162.18
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $100.00 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $60.26 / $97.72
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $524.81