Electrocardiogram (EKG, tracing only)
Facility: Graham County Hospital
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $180
- Cash Discount Price: $225
- vs. Medicare Baseline: 2.99x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Medicaid / KanCare | $33 | 55% |
| UnitedHealthcare | $33 - $214 | 55% |
| Medicare (plans) | $169 | 280% |
| Celtic Commercial-All Other Plans | $186 | 309% |
| Wppa (Providers Care)-All Plans | $214 | 355% |
Consumer Guidance & Cost Commentary
For this electrocardiogram (EKG) service at Graham County Hospital in Hill City, Kansas, the cash price is $225.00, which matches the facility's median negotiated rate. While commercial payers like UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $33 to $214, these figures are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the full $225.00 upfront more cost-effective than relying on insurance, as the negotiated allowed amount could exceed the cash rate. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total out-of-pocket costs compared to the insurance allowed amount.
The facility's cash rate of $225.00 is significantly higher than the Medicare benchmark of $60.27, reflecting the typical markup found in commercial healthcare pricing. Although the data does not provide specific county or state average comparisons for this code, the wide variation in negotiated rates across different payers highlights the importance of checking for "self-pay" or "prompt-pay" discounts before receiving care. If you receive a bill that includes charges for out-of-network services at this in-network facility, you may be eligible for protections under the No Surprises Act, which prevents balance billing for emergency and non-emergency services. Always request an itemized bill to review specific CPT codes and ensure no unbundled charges or services not rendered are included before finalizing payment.