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Initial Preventive Physical Examination

New York 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.

Facilitymedian $132 · 10th–90th $105$2090%20%10th90th$132Professionalmedian $166 · 10th–90th $105$3310%10%10th90th$166$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
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$131.83
Typical High
$239.88
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$128.82
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$141.25
Typical High
$245.47
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$218.78
Typical High
$338.84
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$251.19
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$234.42
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
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$302.00
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$245.47
Typical High
$363.08
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$199.53
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$194.98
Typical High
$363.08
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$758.58
Highmark BCBS
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$165.96
Typical High
$199.53
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$154.88
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$229.09
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$323.59
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$245.47
Typical High
$602.56
Univera
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$141.25
Typical High
$154.88
Univera
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$288.40