EKG tracing at Intermountain Health Lutheran Hospital. CPT 93005.
What Intermountain Health Lutheran Hospital publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$506list price
$21.63–$495range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $93.56 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $116 |
| Kaiser Perm HMO | Kaiser Out Of State | $116 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $116 |
| Allegiance | Cigna Sclhs Employees | $126 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $126 |
| Cigna | Cigna Co Public Option | $129 |
| Cigna | Cigna Connect Exchange | $129 |
| Cigna | Cigna Surefit | $129 |
| Aetna | Aetna Colorado Preferred | $171 |
| Aetna | Aetna HMO/EPO | $183 |
| Aetna | Aetna Indemnity | $183 |
| Aetna | Aetna Other | $183 |
| Aetna | Aetna POS/Qpos | $183 |
| Aetna | Aetna PPO | $183 |
| Aetna | Aetna Src | $183 |
| Aetna | Christian Brothers Emp Ben Trst | $183 |
| Geha | Geha-Asa | $183 |
| Preferred One | Preferred One | $183 |
| BCBS/Anthem | BCBS Co Exchange Plan | $201 |
| BCBS/Anthem | BCBS Co Federal | $201 |
| BCBS/Anthem | BCBS Co HMO | $201 |
| BCBS/Anthem | BCBS Co PPO | $201 |
| Choicecare Humana | Choicecare Humana HMO EPO | $212 |
| Choicecare Humana | Choicecare Humana PPO | $212 |
| Cigna | Cigna HMO | $290 |
| Cigna | Cigna Indemnity | $290 |
| Cigna | Cigna Local Plus | $290 |
| Cigna | Cigna Other | $290 |
| Cigna | Cigna POS/Qpos | $290 |
Inpatient
—cash price (self-pay)
$506list price
$136–$552range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $149 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $213 |
| Kaiser Perm HMO | Kaiser Out Of State | $213 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $213 |
| Kaiser Self Funded | Kaiser Self Funded | $213 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $220 |
| Private Hlthcare Sys | Phcs Other | $379 |
| Private Hlthcare Sys | Phcs PPO | $379 |
| Multiplan Inc | Multiplan Inc Other | $425 |
| Multiplan Inc | Multiplan Inc PPO | $425 |
| BCBS/Anthem | BCBS Co Indemnity | $425 |
| Aetna | Aetna Nap | $454 |
| Cigna | Cigna HMO | $506 |
| Cigna | Cigna Indemnity | $506 |
| Cigna | Cigna Local Plus | $506 |
| Cigna | Cigna Other | $506 |
| Cigna | Cigna POS/Qpos | $506 |
| Cigna | Cigna PPO | $506 |
| Cigna | Eighth Dist Elect Ben Pln | $506 |
| Cigna | Health-Partners | $506 |
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All common services at Intermountain Health Lutheran Hospital