Routine 12-lead ECG screening tracing (no interpretation)

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT, PERFORMED AS A SCREENING FOR THE INITIAL PREVENTIVE PHYSICAL EXAMINATION

Payers reporting HCPCS G0404

Payer pricing summary

Low

Average

$64

Median

$56

High

$220

Payer rate distribution

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1	UnitedHealthcare fee schedule · outpatient · +35 other terms	279	$30	$72	$114	159%	11	$1 – $818
2	Wellmark case rate · outpatient · +23 other terms	13	$23	$77	$117	152%	6–60	$23 – $403
3	Humana fee schedule · outpatient · +28 other terms	274	$26	$29	$19	66%	1–10	$1 – $170
4	Kaiser fee schedule · outpatient · +22 other terms	73	$42	$52	$35	68%	1–10	$5 – $196
5	Aetna fee schedule · outpatient · +30 other terms	346	$29	$35	$23	67%	—	$1 – $170
6	Blue Cross Blue Shield fee schedule · outpatient · +27 other terms	284	$32	$44	$39	91%	—	$1 – $295
7	Cigna fee schedule · outpatient · +28 other terms	130	$30	$45	$60	132%	—	$5 – $563
8	WellCare fee schedule · outpatient · +24 other terms	118	$28	$29	$11	37%	—	$5 – $57
9	Molina fee schedule · outpatient · +27 other terms	110	$29	$33	$21	64%	—	$1 – $179
10	Anthem facility · fee schedule · outpatient · +24 other terms	89	$33	$49	$43	87%	—	$5 – $447
11	Ambetter facility · fee schedule · outpatient · +17 other terms	77	$52	$51	$12	23%	—	$9 – $63
12	Devoted fee schedule · outpatient · +12 other terms	66	$26	$25	$7	28%	—	$6 – $32
13	Optum fee schedule · outpatient · +19 other terms	39	$26	$29	$26	89%	—	$5 – $107
14	MultiPlan fee schedule · outpatient · +15 other terms	34	$48	$49	$28	58%	—	$9 – $121
15	Clover fee schedule · outpatient · +6 other terms	31	$27	$28	$2	7%	—	$24 – $33
16	Oscar fee schedule · outpatient · +17 other terms	30	$37	$31	$27	86%	—	$1 – $83
17	Caresource facility · fee schedule · outpatient · +18 other terms	28	$45	$42	$11	27%	—	$23 – $58
18	Bcbs Tx fee schedule · outpatient · +2 other terms	26	$31	$31	$11	37%	—	$11 – $58
19	Baylor Scott White Health Plan facility · fee schedule · outpatient · +1 other terms	25	$37	$37	$7	20%	—	$28 – $48
20	Medicare fee schedule · outpatient · +11 other terms	24	$6	$11	$9	85%	—	$5 – $29
21	Medica fee schedule · outpatient · +18 other terms	23	$23	$26	$17	65%	—	$5 – $112
22	Regence professional · fee schedule · outpatient · +15 other terms	22	$6	$7	$2	30%	—	$6 – $16
23	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	21	$31	$30	$1	2%	—	$29 – $31
24	Cigna Healthspring fee schedule · outpatient · +5 other terms	17	$24	$19	$9	47%	—	$5 – $26
25	Highmark fee schedule · outpatient · +18 other terms	17	$24	$25	$19	74%	—	$7 – $119

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