Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Medicare pricing data for 96,928 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment (HCPCS code G0402) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $155.38, but hospitals typically charge $340.56 — a 2.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $155.38, your out-of-pocket cost would be approximately $31.08. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.2x more than what Medicare allows for this procedure. Medicare actually pays $155.38 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $197 | $423 | 151 | 622 | +26.5% |
| District of Columbia | $181 | $381 | 212 | 931 | +16.6% |
| New York | $174 | $420 | 5,514 | 26,719 | +12.3% |
| California | $174 | $365 | 6,659 | 30,918 | +11.7% |
| Connecticut | $170 | $360 | 1,328 | 5,067 | +9.6% |
| New Jersey | $169 | $371 | 3,110 | 19,424 | +8.8% |
| Maryland | $168 | $327 | 2,137 | 14,782 | +8.0% |
| Puerto Rico | $167 | $505 | 11 | 22 | +7.2% |
| Massachusetts | $165 | $448 | 3,082 | 16,467 | +6.1% |
| Illinois | $164 | $338 | 3,789 | 25,106 | +5.3% |
| Washington | $162 | $383 | 2,131 | 7,910 | +4.1% |
| Nevada | $159 | $329 | 493 | 2,039 | +2.3% |
| Hawaii | $158 | $268 | 160 | 582 | +1.5% |
| Florida | $157 | $349 | 6,358 | 35,030 | +1.1% |
| Virginia | $157 | $322 | 2,867 | 19,036 | +0.7% |
| Delaware | $155 | $298 | 421 | 3,441 | -0.2% |
| Georgia | $155 | $359 | 2,774 | 16,154 | -0.5% |
| Rhode Island | $154 | $328 | 401 | 1,651 | -0.7% |
| Pennsylvania | $154 | $306 | 4,873 | 28,025 | -0.8% |
| Texas | $154 | $325 | 6,899 | 36,950 | -0.9% |
| Colorado | $153 | $353 | 1,890 | 8,807 | -1.2% |
| Arizona | $153 | $320 | 2,130 | 10,756 | -1.9% |
| Utah | $151 | $286 | 886 | 3,401 | -2.7% |
| Minnesota | $150 | $469 | 2,071 | 7,187 | -3.2% |
| South Carolina | $150 | $338 | 1,717 | 11,542 | -3.2% |
| Wyoming | $150 | $293 | 176 | 1,004 | -3.7% |
| Louisiana | $149 | $271 | 1,036 | 5,593 | -3.9% |
| Indiana | $149 | $297 | 2,215 | 11,816 | -4.0% |
| Oregon | $148 | $437 | 997 | 3,433 | -4.5% |
| North Carolina | $148 | $323 | 3,629 | 17,668 | -4.5% |
| Alabama | $147 | $264 | 1,268 | 5,481 | -5.2% |
| Wisconsin | $147 | $499 | 2,297 | 10,728 | -5.4% |
| Michigan | $146 | $277 | 3,750 | 15,631 | -5.7% |
| Missouri | $146 | $287 | 1,607 | 8,133 | -5.8% |
| New Mexico | $145 | $295 | 450 | 1,900 | -6.7% |
| Kentucky | $144 | $309 | 1,443 | 7,492 | -7.2% |
| Tennessee | $144 | $325 | 2,509 | 14,314 | -7.6% |
| New Hampshire | $143 | $330 | 686 | 3,216 | -7.7% |
| Ohio | $143 | $303 | 4,477 | 21,707 | -7.8% |
| Iowa | $143 | $323 | 1,123 | 7,336 | -7.9% |
| Montana | $143 | $319 | 367 | 2,025 | -8.0% |
| West Virginia | $142 | $300 | 497 | 2,320 | -8.5% |
| Oklahoma | $142 | $293 | 1,053 | 5,833 | -8.6% |
| Mississippi | $141 | $223 | 638 | 3,120 | -9.5% |
| Kansas | $140 | $293 | 921 | 5,994 | -9.8% |
| South Dakota | $140 | $262 | 214 | 1,196 | -9.9% |
| Nebraska | $139 | $324 | 822 | 5,012 | -10.8% |
| Arkansas | $138 | $284 | 938 | 4,805 | -11.2% |
| Vermont | $137 | $213 | 237 | 1,103 | -11.9% |
| Idaho | $134 | $281 | 653 | 2,529 | -13.9% |
| North Dakota | $130 | $287 | 263 | 1,090 | -16.4% |
| Maine | $124 | $304 | 545 | 1,716 | -20.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber