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Initial Preventive Physical Examination

Pennsylvania 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 $120 · 10th–90th $71$1620%20%10th90th$120Professionalmedian $158 · 10th–90th $105$2630%20%10th90th$158$50.0$200.0$1.0K$5.0K$20.0K

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
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$120.23
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$257.04
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$177.83
Typical High
$346.74
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$154.88
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$181.97
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$169.82
Typical High
$275.42
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
$257.04
Median
$257.04
Typical High
$257.04
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$269.15
Typical High
$354.81
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$186.21
Typical High
$316.23
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$75.86
Typical High
$147.91
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$151.36
Typical High
$275.42
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$104.71
Median
$173.78
Typical High
$346.74
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$199.53
Typical High
$363.08
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$114.82
Typical High
$199.53
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$128.82
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$389.05
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$275.42