go back

Utah 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
$3.98 / $6.31 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.62 / $7.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $10.00 / $12.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $8.71 / $16.60
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $9.33 / $12.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $10.00 / $15.14