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New Hampshire rates for HCPCS G0404

Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.74 / $8.41 / $14.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.15 / $12.61 / $22.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $5.65 / $5.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $11.12 / $23.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $13.95 / $24.40
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $9.34 / $3,375.00