Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Medicare pricing data for 97,753 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
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit (HCPCS code G0438) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $150.68, but hospitals typically charge $363.82 — a 2.4x 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 $150.68, your out-of-pocket cost would be approximately $30.14. 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 2.4x more than what Medicare allows for this procedure. Medicare actually pays $150.68 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $197 | $463 | 168 | 1,118 | +30.7% |
| District of Columbia | $182 | $397 | 244 | 1,388 | +20.9% |
| New York | $170 | $476 | 6,197 | 49,492 | +12.9% |
| Connecticut | $169 | $488 | 1,055 | 5,300 | +12.4% |
| Maryland | $165 | $341 | 2,147 | 19,310 | +9.8% |
| California | $165 | $354 | 7,496 | 61,697 | +9.3% |
| Illinois | $165 | $376 | 4,050 | 32,835 | +9.2% |
| Puerto Rico | $162 | $252 | 32 | 117 | +7.3% |
| Washington | $161 | $411 | 2,427 | 14,354 | +7.0% |
| Virginia | $158 | $328 | 2,612 | 19,721 | +5.1% |
| Minnesota | $156 | $456 | 2,752 | 18,818 | +3.8% |
| Texas | $156 | $332 | 6,577 | 39,788 | +3.3% |
| Massachusetts | $156 | $462 | 3,038 | 22,212 | +3.3% |
| New Hampshire | $155 | $400 | 487 | 1,869 | +3.1% |
| Florida | $155 | $352 | 6,070 | 44,296 | +2.9% |
| South Dakota | $155 | $248 | 273 | 2,734 | +2.6% |
| Utah | $154 | $297 | 833 | 4,681 | +2.4% |
| Nevada | $154 | $322 | 745 | 5,968 | +2.0% |
| Georgia | $153 | $385 | 2,535 | 18,414 | +1.6% |
| Wyoming | $153 | $274 | 174 | 1,444 | +1.4% |
| New Jersey | $153 | $384 | 3,096 | 21,197 | +1.4% |
| Arizona | $152 | $342 | 2,021 | 13,761 | +0.9% |
| Delaware | $152 | $301 | 382 | 3,807 | +0.7% |
| Wisconsin | $151 | $531 | 2,177 | 11,361 | +0.2% |
| South Carolina | $150 | $326 | 1,732 | 16,538 | -0.2% |
| West Virginia | $150 | $319 | 471 | 2,821 | -0.3% |
| Vermont | $149 | $328 | 208 | 1,086 | -1.0% |
| Louisiana | $148 | $292 | 988 | 9,682 | -1.5% |
| North Carolina | $148 | $331 | 3,694 | 22,494 | -1.6% |
| New Mexico | $147 | $343 | 448 | 2,432 | -2.7% |
| Indiana | $146 | $302 | 2,532 | 20,129 | -2.8% |
| Alabama | $146 | $297 | 1,100 | 5,776 | -2.9% |
| Iowa | $146 | $357 | 1,206 | 11,115 | -2.9% |
| Tennessee | $145 | $342 | 2,109 | 12,173 | -3.8% |
| Idaho | $145 | $308 | 424 | 2,054 | -4.1% |
| Mississippi | $144 | $268 | 725 | 6,508 | -4.5% |
| Hawaii | $142 | $304 | 242 | 1,415 | -5.7% |
| Rhode Island | $142 | $377 | 330 | 1,828 | -5.7% |
| Missouri | $137 | $335 | 1,593 | 12,008 | -9.1% |
| Pennsylvania | $136 | $340 | 4,886 | 37,522 | -9.4% |
| Nebraska | $135 | $362 | 827 | 10,265 | -10.4% |
| Colorado | $133 | $352 | 1,579 | 9,461 | -11.7% |
| Kentucky | $132 | $332 | 1,520 | 10,016 | -12.3% |
| Kansas | $130 | $316 | 1,004 | 8,808 | -13.8% |
| North Dakota | $129 | $448 | 324 | 2,589 | -14.3% |
| Ohio | $128 | $342 | 4,307 | 29,061 | -15.2% |
| Michigan | $128 | $301 | 3,646 | 18,070 | -15.3% |
| Oregon | $126 | $462 | 1,272 | 7,104 | -16.3% |
| Oklahoma | $118 | $321 | 1,114 | 9,375 | -21.5% |
| Montana | $118 | $356 | 370 | 2,251 | -21.6% |
| Arkansas | $116 | $304 | 990 | 7,794 | -23.2% |
| Maine | $100 | $307 | 462 | 1,670 | -33.5% |
⚠️ 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