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Preventive Visit, Established Patient, Age 65+

North Carolina rates for HCPCS 99397

This is a routine preventive checkup for an established patient age 65 or older, focused on prevention rather than a specific complaint. It typically includes a physical exam, review of medications and chronic conditions, and screening recommendations appropriate for the patient's age.

Rates data updated July 2026.

How much does Preventive Visit, Established Patient, Age 65+ cost?

$158

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $135 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$158$117 to $219
FacilityA hospital or hospital-owned outpatient department$135$110 to $174

How much rates vary

Facilitymedian $135 · 10th to 90th $91 to $245Professionalmedian $158 · 10th to 90th $98 to $302
$100$200$500facility $135professional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$251.19
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$131.83
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$138.04
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$186.21
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$263.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$141.25
Typical High
$251.19
Medcost
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$131.83
Typical High
$218.78
Medcost
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$338.84
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$194.98
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$151.36
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$123.03
Typical High
$213.80
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14

Where North Carolina sits

The same service costs 2.1 times more in Minnesota than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

North Carolina· 11th of 51

$158

MN $224DE $107

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.