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Annual Wellness Visit, Initial

New York rates for HCPCS G0438

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

Rates data updated July 2026.

Facilitymedian $148 · 10th–90th $102$4470%10%20%10th90th$148Professionalmedian $186 · 10th–90th $107$4270%5%10%10th90th$186$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
$102.33
Median
$147.91
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$346.74
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$208.93
Typical High
$338.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$165.96
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$154.88
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$269.15
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
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
$165.96
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$151.36
Typical High
$616.60
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
$199.53
Typical High
$354.81
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$190.55
Typical High
$251.19
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$154.88
Median
$177.83
Typical High
$181.97
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$234.42
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$177.83
Typical High
$389.05
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$269.15
Typical High
$1,202.26
Univera
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$177.83
Univera
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$288.40