Electrocardiogram (EKG, tracing only)
Facility: Mitchell County Hospital Health Systems
Billing Code: 93005 (CPT)
- CPT Billing Code: 93005
- Insurance Median: $252
- Cash Discount Price: $239
- vs. Medicare Baseline: 4.18x 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 418% of the Medicare baseline (a markup of 318%). 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 |
|---|---|---|
| UnitedHealthcare | $60 - $265 | 100% |
| Blue Cross Blue Shield | $164 | 272% |
| Triwest Well Mark All Plans | $225 | 373% |
| Aetna | $238 | 395% |
| Pref Hlth Care Sytms Comm - All Plans | $238 | 395% |
| First Health-All Plans | $238 | 395% |
| Auxiant-All Plans | $252 | 418% |
| Multiplan Ppo - All Plans | $252 | 418% |
| Phc Leased Ntwrk Access - All Plans | $252 | 418% |
| Health Partners Ks-All Plans | $262 | 435% |
| Cigna | $262 | 435% |
Consumer Guidance & Cost Commentary
For the CPT code 93005, Electrocardiogram (EKG, tracing only), the facility in Beloit, KS, has a cash price of $239.00, which is lower than the gross charge of $265.00. While the median negotiated rate across 11 payers is $252.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that the cash price of $239.00 is higher than the Medicare benchmark of $60.27, indicating a significant markup relative to the federal government's fixed reimbursement rate. Additionally, the facility's cash rate is notably higher than the lowest negotiated rate of $60.00 observed for UnitedHealthcare, highlighting the variance in commercial pricing structures.
To minimize costs, patients should inquire about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead of insurance claims. Since the facility is a Critical Access Hospital with government local ownership, verifying self-pay rates before scheduling is crucial to avoid being billed the full negotiated amount. Furthermore, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should ensure they receive an itemized bill to confirm no unexpected charges exist. Always request a written waiver of insurance submission if you intend to pay cash directly, as automatic claims processing can void any potential cash discounts.