How much do preventive care procedures cost?

Medicare benchmark rates for common preventive care procedures range from $172.19 to $207.57. Commercial insurers typically pay 1.2–2× these rates. Your actual cost depends on your plan, deductible, and whether the provider is in network.

How do I know if my preventive care bill is too high?

Compare the amount you were charged to the Medicare benchmark for that specific CPT code. If your bill is more than about 2–3× the Medicare rate, it may be worth requesting an itemized bill and negotiating or appealing.

Preventive Care Costs

Medicare benchmark rates for 4 common preventive care procedures, ranging from $172.19 to $207.57. Use these as a reference to check whether your bill is fair.

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Annual Physical - New Patient, Age 18-39CPT 99385$175.97Medicare rate Annual Physical - New Patient, Age 40-64CPT 99386$207.57Medicare rate Annual Physical - Established Patient, Age 18-39CPT 99395$172.19Medicare rate Annual Physical - Established Patient, Age 40-64CPT 99396$192.10Medicare rate

Understanding preventive care costs

Under the Affordable Care Act, a defined list of preventive services — annual wellness visits, many screenings, and routine immunizations — must be covered at no cost to you when delivered in-network. When a preventive visit generates a bill, the cause is usually a coding issue rather than a real charge.

For preventive care services, commercial insurers typically pay between $206.63 and $415.14 across this category — roughly 1.2 to 2 times Medicare. If you were billed significantly more than the commercial range for your specific procedure, the excess may be negotiable.

Click any procedure above to see its detailed Medicare rate, the typical commercial range, and specific steps for disputing an overcharge.

Common billing problems with preventive care charges

Preventive visit converted to a diagnostic one

If you mention a new symptom during a wellness visit and the provider addresses it, the visit can be partly recoded as diagnostic (problem-oriented), which is cost-shared. Ask whether a diagnostic E/M code was added and whether it was truly separate from the preventive service.

Wrong diagnosis code attached to a screening

A screening test billed with a diagnostic (rather than screening) diagnosis code can flip a $0 preventive service into a cost-shared one. This is a coding correction your provider can make and resubmit.

Out-of-network preventive care

The no-cost-sharing rule applies to in-network preventive care. If the provider or lab was out-of-network, preventive protection may not apply.

How to push back on a preventive care charge

Preventive billing disputes are usually won by correcting the diagnosis or visit code, not by negotiating a discount. Ask your provider's billing office to review whether the service qualifies as ACA-preventive and to resubmit if it was miscoded.

Rates shown are 2024 CMS Medicare national average payment rates and are provided for informational purposes only. Actual payments vary by geographic area, facility type, and payer contract. This is not medical or financial advice.