CMS Price Transparency Data

Electrocardiogram (EKG, tracing only)

Facility: Boston Children's Hospital

Billing Code: 93005 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93005
Insurance Median: $214
Cash Discount Price: $301
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Electrocardiogram (EKG, tracing only) at Boston Children's Hospital is $214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $301. Compared to the federal Medicare reimbursement reference rate of $60.27, this hospital’s rate is 3.55x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$301

Average discount available for prompt cash payment at this facility.

Insurance Median

$214

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$60.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $60.27 (100%)

Cash / Self-Pay: $301 (499%)

Insurance Median: $214 (355%)

Cash: $301 (499% of Medicare)

Ins. Median: $214 (355% of 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 355% of the Medicare baseline (a markup of 255%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Unicare	$92	153%
Blue Cross Blue Shield	$135 - $199	224%
Cdphp	$147 - $256	244%
Harvard Pilgrim	$153 - $203	254%
United	$180 - $251	299%
Aetna	$181 - $252	300%
Mgb/Allways	$183 - $223	304%
Tufts Public Plan	$185	307%
Ambetter / Centene	$190	315%
United Ri Nj Ny	$190	315%
Carelon Strategies/Bhs	$196	325%
UnitedHealthcare	$196 - $256	325%
Carelon/Beacon	$226	375%
Fallon	$230 - $232	382%
Health New England	$243	403%
Cigna	$256 - $272	425%
Ets/Lifetrac	$256	425%
Interlink Transplant	$256	425%
Community Health Options	$271	450%
Humana	$271	450%
Coventry/Hcvm/First Health	$277	460%
Multiplan/Phcs	$277 - $286	460%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $301.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 93005.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Boston Children's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 93005.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.