Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination
What Medicare pays for G0404, what providers bill, and how the price varies across 38 states, drawn from CMS 2023 claims data.
G0404 · the short answer
For electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination, Medicare pays about $2.95 on average across 38 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $2.95
- Providers bill
- $38.34
- States with data
- 38
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Preventive Screening procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| New York | $4.34 | $41.93 |
| California | $4.12 | $37.12 |
| Arizona | $3.82 | $43.50 |
| Maryland | $3.62 | $52.63 |
| New Hampshire | $3.59 | $89.95 |
| Florida | $3.40 | $24.72 |
| Massachusetts | $3.30 | $33.82 |
| Pennsylvania | $3.21 | $32.02 |
| Colorado | $3.20 | $48.11 |
| South Carolina | $3.14 | $32.32 |
| Washington | $3.12 | $36.26 |
| Wyoming | $3.04 | $51.30 |
| Oregon | $2.97 | $20.99 |
| Kentucky | $2.89 | $18.02 |
| South Dakota | $2.88 | $49.19 |
| Virginia | $2.88 | $33.12 |
| Illinois | $2.86 | $40.65 |
| New Mexico | $2.76 | $51.30 |
| Kansas | $2.76 | $29.51 |
| North Carolina | $2.74 | $32.81 |
| Michigan | $2.73 | $30.00 |
| Utah | $2.69 | $21.16 |
| Nebraska | $2.69 | $24.40 |
| Texas | $2.64 | $24.18 |
| Oklahoma | $2.63 | $26.14 |
| Arkansas | $2.57 | $10.67 |
| Minnesota | $2.54 | $41.15 |
| Ohio | $2.52 | $78.21 |
| Missouri | $2.48 | $23.53 |
| Tennessee | $2.45 | $45.52 |
| Montana | $2.44 | $53.46 |
| Iowa | $2.37 | $26.65 |
| Wisconsin | $2.33 | $89.16 |
| Indiana | $2.32 | $37.22 |
| Idaho | $2.19 | $16.31 |
| Georgia | $2.17 | $26.64 |
| North Dakota | $2.17 | $84.12 |
| Mississippi | $1.56 | $42.33 |
What the Data Says About Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination
Across 38 states with reporting providers, CPT code G0404 (Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination) shows a national average Medicare payment of $2.95 against an average billed charge of $38.34. That gap, a 13.0x markup, or 1201% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Preventive Screening procedures like this one saw 5.4K services billed to Medicare in 2023 by 2.3K distinct providers, serving 5.4K unique beneficiaries. State-level variation is significant: Mississippi reports the lowest average payment at $1.56, while New York reports the highest at $4.34. A 179% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Preventive Screening category (2.24x), the estimated commercial insurance price lands near $14.06, with self-pay cash discounts commonly bringing the figure closer to $15.25. Within Preventive Screening, Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination ranks #34 of 34 tracked procedures by national average Medicare payment.
What to do with this
If you may have electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination cost?
Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination (CPT G0404) shows unusually wide state-to-state pricing: Medicare pays $2.95 on average nationally, but the $1.56-$4.34 range across states spans more than double from cheapest to priciest.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination cost with insurance?
With commercial insurance, electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination costs an estimated $14.06 on average (range: $9.84-$19.69), a moderate premium over Medicare's $2.95. Without insurance, the estimated cash price is $15.25.
Which state has the lowest cost for Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination?
Mississippi has by far the lowest average Medicare payment for Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination at $1.56, while New York pays more than double at $4.34 - a $2.79 gap.
How many providers perform Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination?
A moderate provider base performs Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination: 2.3K providers nationally, totaling 5.4K Medicare-billed services (5.4K beneficiaries) across 38 states in 2023.
What is the billed-to-Medicare markup for Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination?
Providers bill 13.0x what Medicare pays for Electrocardiogram, Routine Ecg With 12 Leads; Tracing Only, Without Interpretation And Report, Performed As A Screening For The Initial Preventive Physical Examination - a markup within the typical range at 1201% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.