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Initial Preventive Physical Examination

North Carolina rates for HCPCS G0402

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

Rates data updated July 2026.

How much does Initial Preventive Physical Examination cost?

$170

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $170 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $162 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$174$138 to $240
FacilityA hospital or hospital-owned outpatient department$162$135 to $204

How much rates vary

Facilitymedian $162 · 10th to 90th $120 to $269Professionalmedian $174 · 10th to 90th $120 to $339
$100$200$500facility $162professional $174

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
$131.83
Median
$162.18
Typical High
$223.87
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$154.88
Typical High
$263.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$162.18
Typical High
$467.74
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Medcost
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$165.96
Medcost
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$162.18
Typical High
$269.15
Medcost
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$407.38
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$208.93
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$251.19
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,348.96

Where North Carolina sits

The same service costs 1.9 times more in Minnesota than in Kentucky. 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· 7th of 51

$170

MN $257KY $132

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.