CMS Price Transparency Data

Electrocardiogram (EKG, tracing only)

Facility: Tomah Memorial Hospital

Billing Code: 93005 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93005
Insurance Median: $93
Cash Discount Price: $157
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Electrocardiogram (EKG, tracing only) at Tomah Memorial Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $60.27, this hospital’s rate is 1.54x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $157 (260%)

Insurance Median: $93 (154%)

Cash: $157 (260% of Medicare)

Ins. Median: $93 (154% 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.

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
Blue Cross Blue Shield	$42 - $251	70%
Independent Care Mcaid	$42	70%
Managed Hlth Mcaid - All Plans	$42	70%
Quartz Mcaid	$42	70%
Security Hp Mcaid	$42	70%
Group Hlth Mcr Adv - All Plans	$93	154%
Humana	$93 - $252	154%
Independent Care Mcr - All Other Plans	$93	154%
Quartz Mcr Adv	$93	154%
Security Hp Mcr Adv	$93	154%
UnitedHealthcare	$93 - $257	154%
Va Ccn - All Plans	$93	154%
Aetna	$177 - $232	294%
Cigna	$207 - $265	343%
Security Hp Comm - All Other Plans	$232	385%
Quartz Comm - All Other Plans	$245	407%
The Alliance - All Plans	$254	421%

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 $157.
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 Tomah Memorial 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.