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South Dakota 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
$5.75 / $7.08 / $26.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.08 / $8.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $13.80 / $97.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $12.59 / $14.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $16.98 / $16.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $10.72 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $14.79 / $20.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.55 / $11.22