go back

Annual Wellness Visit, Initial

North Carolina 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?

$214

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $214 for this service. The price depends on where it is billed: about $219 from a physician practice, and about $191 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$219$162 to $295
FacilityA hospital or hospital-owned outpatient department$191$162 to $234

How much rates vary

Facilitymedian $191 · 10th to 90th $148 to $324Professionalmedian $219 · 10th to 90th $135 to $407
$100$200$500$1Kfacility $191professional $219

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
$162.18
Median
$162.18
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$162.18
Typical High
$302.00
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$158.49
Typical High
$354.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$154.88
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$154.88
Typical High
$154.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$239.88
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$177.83
Medcost
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$263.03
Typical High
$263.03
Medcost
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$186.21
Typical High
$309.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$416.87
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$302.00
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$309.03
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,047.13
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 1.7 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.

North Carolina· 2nd of 51

$214

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.