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.
Original text from hospital filings
PR Ecg 12 Lead Interpretation W/Report Initial Preventive Physical Exam
Low
$9
Average
$18
Median
$13
High
$63
Each hospital's average Premera rate, under the methodology and billing class chosen below.
14 hospitals; the 90th percentile is 3.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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22 hospital rates
iThe hospitals that file a Premera rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 2 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 3 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 4 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 5 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 6 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 7 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · inpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 8 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 9 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · inpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 10 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 11 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · both | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 12 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · inpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 13 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 14 | Plymouth Medical Center Plymouth, IN professional · fee schedule · inpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 15 | Plymouth Medical Center Plymouth, IN professional · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 16 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · both | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 17 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 18 | Samaritan Hospital Troy, NY professional · percent of total billed charges · inpatientfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 19 | Samaritan Hospital Troy, NY professional · percent of total billed charges · outpatientfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 20 | St Joseph Mercy Ann Arbor Ypsilanti, MI professional · fee schedule · inpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 21 | St Joseph Mercy Ann Arbor Ypsilanti, MI professional · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 22 | Virginia Mason Medical Center Seattle, WA professional · fee schedule · outpatient | 2 | $13 | $13 | $5 | 35% | — | $9 – $18 |
← Payers reporting HCPCS G0405 · Snapshot 20261111T120946Z-9134e7f7