Electrocardiogram (EKG, tracing only)
Facility: Stormont Vail Hospital
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $55
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.91x 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 |
|---|---|---|
| UnitedHealthcare | $21 | 35% |
| Ambetter / Centene | $21 | 35% |
| Blue Cross Blue Shield | $21 - $425 | 35% |
| Humana | $53 - $55 | 88% |
| Aetna | $53 - $55 | 88% |
Consumer Guidance & Cost Commentary
For this Electrocardiogram (EKG) service at Stormont Vail Hospital in Topeka, KS, the facility's negotiated payment rate is $55.00, which matches the median negotiated amount reported for this procedure in the state. This rate is significantly lower than the facility's gross charge of $403.00, reflecting the contractual agreements that protect in-network patients from balance billing. While commercial payers like UnitedHealthcare and Ambetter / Centene have a single plan paying the full $55.00, other insurers such as Blue Cross Blue Shield and Humana have negotiated rates ranging from $53.00 to $425.00 depending on the specific plan. Because the facility is an in-network Acute Care Hospital, the No Surprises Act generally prevents balance billing for emergency or non-emergency services, meaning patients should not face unexpected bills for the difference between the chargemaster and the allowed amount.
Patients should be aware that cash-pay rates for this service are not available in the current data, so the $55.00 negotiated rate serves as the primary benchmark for self-pay inquiries. However, it is important to note that cash payments can sometimes be cheaper than insurance negotiated rates if a patient has a high deductible and the insurer's allowed amount exceeds the cash price. Since the facility is a voluntary non-profit, patients are encouraged to contact the billing department directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling. To ensure accuracy, patients should request a full itemized bill rather than accepting a summary invoice, as detailed line items can reveal unbundled codes or services not rendered. Finally, comparing this $5