CMS Price Transparency Data

Electrocardiogram (EKG, tracing only)

Facility: Stoughton Hospital

Billing Code: 93005 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93005
Insurance Median: $130
Cash Discount Price: $164
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Electrocardiogram (EKG, tracing only) at Stoughton Hospital is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $60.27, this hospital’s rate is 2.16x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $164 (272%)

Insurance Median: $130 (216%)

Cash: $164 (272% of Medicare)

Ins. Median: $130 (216% 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 216% of the Medicare baseline (a markup of 116%). 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
Medicaid / KanCare	$32	53%
Tricare	$71	118%
Healthnet Mcr Adv - All Plans	$79	131%
Dean Health Insurance Med Adv	$83	138%
Humana	$83 - $268	138%
Quartz Mcr Adv	$83	138%
Security Health/First Health - All Plans	$83	138%
Aetna	$89 - $253	148%
Dean Health Insurance Comm - All Other Plans	$115	191%
Dean Health Insurance Epo	$115	191%
Quartz Health Solutions - All Other Lans	$130	216%
UnitedHealthcare	$131 - $238	217%
Alliance - All Plans	$173	287%
Geha - All Plans	$224	372%
Cigna	$238	395%
Wisconsin Ppo Ppa Direct - All Plans	$238	395%
Blue Cross Blue Shield	$259	430%
Wps - All Plans	$268	445%

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 $164.
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 Stoughton 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.