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Annual Wellness Visit, Initial

Pennsylvania 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 $148$2400%50%90th$148Professionalmedian $170 · 10th–90th $132$2950%20%10th90th$170$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
$147.91
Median
$147.91
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$173.78
Typical High
$316.23
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
$165.96
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$154.88
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
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$239.88
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$151.36
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$269.15
Typical High
$354.81
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$218.78
Typical High
$331.13
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$158.49
Typical High
$177.83
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$181.97
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$309.03
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$114.82
Median
$177.83
Typical High
$263.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$234.42
Typical High
$380.19
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$199.53
Typical High
$199.53
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$169.82
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$190.55
Typical High
$323.59