Electrocardiogram (EKG, tracing only)
Facility: Nmc Health
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $45
- Cash Discount Price: $78
- vs. Medicare Baseline: 0.75x 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 |
|---|---|---|
| Bluestem Pace | $6 - $56 | 10% |
| Leading Age | $10 - $90 | 17% |
| Medicaid / KanCare | $10 - $90 | 17% |
| Wppa | $19 - $102 | 32% |
| Occunet | $21 - $112 | 35% |
| Samaritan Ministries International | $23 - $121 | 38% |
| Aetna | $23 - $153 | 38% |
| Medincrease Health Plan | $23 - $121 | 38% |
| Prime Health Services | $26 - $140 | 43% |
| UnitedHealthcare | $32 - $167 | 53% |
| Cigna | $33 - $177 | 55% |
| Blue Cross Blue Shield | $164 | 272% |
Consumer Guidance & Cost Commentary
For this electrocardiogram (EKG) service at Nmc Health in Newton, KS, the cash price of $78.00 is significantly lower than the facility's gross charge of $186.00. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $23 to $167, the cash price offers a substantial alternative for patients with high-deductible plans or those without insurance. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, self-pay patients should explicitly request a "prompt-pay" discount or "self-pay" classification before scheduling to ensure they receive the lowest possible rate.
The facility's cash rate of $78.00 is notably higher than the state average for this procedure, which is approximately $60.27 (the Medicare benchmark). This difference highlights that while Medicare represents a scientifically validated baseline for the true cost of care, commercial rates can vary widely based on network agreements. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law, but unexpected charges can still occur if ancillary services are out-of-network. To avoid errors, consumers should demand a full itemized bill before paying and verify that all services rendered are accurately coded, as over 80% of hospital bills contain discrepancies that can be resolved through a formal audit.