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South Dakota 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 $65 · 10th–90th $39–$1200%10%20%10th90th$65Professionalmedian $54 · 10th–90th $32–$1050%10%10th90th$54$50.0$100.0$200.0

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
$38.90 / $41.69 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $41.69 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $60.26 / $91.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $69.18 / $123.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $104.71 / $407.38
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $93.33 / $151.36
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $147.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $81.28 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $69.18 / $120.23
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $66.07 / $109.65