Electrocardiogram (EKG, tracing only)
Facility: Ellsworth County Medical Center
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $306
- Cash Discount Price: $340
- vs. Medicare Baseline: 5.08x 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 508% of the Medicare baseline (a markup of 408%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $155 - $163 | 257% |
| Triwest -All Plans | $160 | 265% |
| Healthy Blue Mcr Adv | $160 | 265% |
| Va Ccn-All Plans | $160 | 265% |
| Humana | $160 - $323 | 265% |
| UnitedHealthcare | $221 - $340 | 367% |
| Aetna | $306 | 508% |
| First Health - All Plans | $306 | 508% |
| Cigna | $323 | 536% |
| Healthy Blue Mcaid- All Other Plans | $340 | 564% |
| Coventry Mcaid-All Plans | $340 | 564% |
| Medicaid / KanCare | $340 | 564% |
| Providers Care-Wppa-All Plans | $510 | 846% |
Consumer Guidance & Cost Commentary
For the CPT code 93005, representing an Electrocardiogram (EKG, tracing only), the gross charge at Ellsworth County Medical Center is $340.00. While the facility's cash median rate is $340.00, the negotiated rates paid by insurance plans range significantly lower, with the lowest allowed amount being $155 and the median negotiated rate across all payers at $306.00. This structure highlights a common billing dynamic where commercial insurance contracts often result in lower out-of-pocket costs for members compared to the full cash price, particularly for those with high-deductible plans. However, patients should be aware that if their insurance allows a rate higher than the cash price, paying out-of-pocket directly may be more economical. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final cost.
The pricing for this service at this Critical Access Hospital in Ellsworth, KS, is benchmarked against federal standards to ensure transparency. The Medicare amount for this procedure is $60.27, which serves as the objective baseline for evaluating the facility's pricing markup. Commercial negotiated rates in this region typically average 200% to 300% of the Medicare rate, reflecting the administrative costs and contract dynamics inherent in the insurance system. For consumers, it is crucial to understand that comparing rates to the hospital's gross chargemaster list can be misleading; instead, comparing the allowed amount to the Medicare rate provides a clearer picture of the true cost of care. Additionally, patients should request a detailed, itemized bill