CMS Price Transparency Data

Electrocardiogram (EKG, tracing only)

Facility: St Nicholas Hospital

Billing Code: 93005 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93005
  • Insurance Median: $170
  • Cash Discount Price: $187
  • vs. Medicare Baseline: 2.82x Medicare
The contracted insurance negotiated median rate for a Electrocardiogram (EKG, tracing only) at St Nicholas Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $187. Compared to the federal Medicare reimbursement reference rate of $60.27, this hospital’s rate is 2.82x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$187

Average discount available for prompt cash payment at this facility.

Insurance Median
$170

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: $187 (310%)
Insurance Median: $170 (282%)
Cash: $187 (310% of Medicare)
Ins. Median: $170 (282% 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 282% of the Medicare baseline (a markup of 182%). 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.

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
Blue Cross Blue Shield $11 - $190 18%
Community Care Family Care $11 18%
Managed Health Services $11 18%
Medicaid / KanCare $11 18%
Meridian Health Plan $11 18%
Molina Healthcare $12 - $57 20%
Triology $12 - $224 20%
Security Health Plan $23 - $181 38%
Aetna $57 - $283 95%
Humana $57 - $241 95%
Medica $57 95%
Medicare (plans) $57 95%
UnitedHealthcare $57 - $148 95%
Naphcare $129 214%
P360 Small Group $134 222%
Prevea Health Network $134 222%
Molina Healthcare Of Wi $142 236%
Hshs Employees $153 254%
Arise Health Plan $170 282%
Wea Provider Network $175 - $204 290%
Cigna $198 329%
Interplan $198 329%
Network Health Plan $198 329%
Health Care Alliance $207 343%
Health Eos $212 352%
Healthsmart $212 352%
Wisconsin Physician Service $226 375%
Multiplan/Phcs $238 395%
Choicecare $241 400%
North Central Healthcare Alliance $260 431%
First Health $269 446%
Caterpillar, Inc. $283 470%
Cofinity $283 470%
Live360 $283 470%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals