Electrocardiogram (EKG, tracing only)
Facility: Saint John Hospital
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $56
- Cash Discount Price: $55
- vs. Medicare Baseline: 0.93x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $60.27 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Oha Networks | $14 | 23% |
| Aetna | $15 - $56 | 25% |
| Worker Compensation | $15 | 25% |
| Medicaid / KanCare | $21 | 35% |
| Celtic | $21 - $89 | 35% |
| UnitedHealthcare | $21 - $78 | 35% |
| Healthy Blue | $21 - $58 | 35% |
| Cigna | $56 | 93% |
| Medicare (plans) | $56 | 93% |
| Midland Care Connection | $56 | 93% |
| Tricare | $56 | 93% |
| Kansas Superior Select | $57 | 95% |
| Well Path | $78 | 129% |
| Corizon | $78 | 129% |
| Blue Cross Blue Shield | $78 - $164 | 129% |
| Employer Direct Healthcare | $78 | 129% |
| Centurion | $83 | 138% |
| Naphcare | $86 | 143% |
Consumer Guidance & Cost Commentary
For this electrocardiogram (EKG) service at Saint John Hospital in Leavenworth, KS, the facility's cash price of $55.00 is significantly lower than the state average of $387.00, making it a cost-effective option for patients paying out-of-pocket. While commercial insurance carriers like Aetna and Celtic have negotiated rates ranging from $15 to $89, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the $55.00 cash rate directly, provided they verify that their insurance negotiated rate is higher; however, they should confirm with the hospital regarding "self-pay" or "prompt-pay" discounts that could further reduce the final bill.
The facility's negotiated rates align closely with the Medicare benchmark of $60.27, which serves as a reliable baseline for evaluating fair pricing, whereas the gross charge of $774.00 represents a substantial markup. Although the hospital is a voluntary non-profit, the presence of multiple payers with varying plan limits suggests that individual coverage details will dictate the final out-of-pocket cost. To ensure accuracy, patients should request a full itemized billing audit before payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if a patient receives care from an out-of-network provider at this facility, they may be subject to balance billing, though the No Surprises Act protects against such charges for emergency services and non-emergency care from out-of-network providers at in-network facilities.