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Annual Wellness Visit, Initial

Illinois rates for HCPCS G0438

Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit

Rates data updated July 2026.

How much does Annual Wellness Visit, Initial cost?

$182

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $182 for this service. The price depends on where it is billed: about $182 from a physician practice, and about $209 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 7 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$182$158 to $219
FacilityA hospital or hospital-owned outpatient department$209$191 to $275

How much rates vary

Facilitymedian $209 · 10th to 90th $170 to $380Professionalmedian $182 · 10th to 90th $135 to $288
$100$200$500facility $209professional $182

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
$169.82
Median
$199.53
Typical High
$380.19
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$169.82
Typical High
$295.12
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$177.83
Typical High
$263.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$154.88
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$154.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$263.03
Typical High
$645.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$186.21
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$263.03
Typical High
$407.38
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$204.17
Typical High
$218.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$169.82
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$190.55
Typical High
$288.40
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$208.93
Typical High
$331.13

Where Illinois sits

The same service costs 1.7 times more in Minnesota than in Texas. 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.

Illinois· 13th of 51

$182

MN $257TX $148

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.