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Pennsylvania 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
$5.43 / $6.38 / $13.32
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.33 / $6.27 / $14.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $5.65 / $5.65
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.84 / $9.88 / $18.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.43 / $6.91 / $30.02
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.55 / $17.60 / $23.40
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $5.65 / $5.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.91 / $6.00 / $11.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.93 / $10.39 / $17.35