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Pennsylvania 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 $62 · 10th–90th $37–$1150%20%10th90th$62Professionalmedian $55 · 10th–90th $36–$890%10%20%10th90th$55$1.0$10.0$100.0$1.0K$10.0K

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
$37.15 / $72.44 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $75.86
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $66.07 / $107.15
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 / $60.26
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $100.00 / $134.90
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $70.79 / $114.82
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $37.15 / $57.54
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $77.62
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $117.49 / $147.91
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $61.66 / $61.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $60.26 / $72.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $199.53 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $60.26 / $102.33