EKG tracing at CHI Health Good Samaritan. CPT 93005.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$285cash price (self-pay)
$488list price
$11.55–$473range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $11.55 |
| Medica | Commercial|CHI Health | $11.64 |
| Medica | Commercial|All Other Plans | $12.19 |
| Amerigroup | Medicaid|All Plans | $48.38 |
| Centene | Medicaid|IA Total Care | $48.38 |
| IAMolina | Medicaid|All Plans | $49.33 |
| BCBS - NE | Medicare|All Plans | $56.24 |
| Humana | Medicare|All Plans | $56.24 |
| Medica | Medicare|All Plans | $56.24 |
| PACE | Medicare|All Plans | $56.24 |
| United | Medicare|All Plans | $56.24 |
| Centene | Medicare|All Plans | $57.93 |
| Amerigroup | Medicare|All Plans | $59.05 |
| Great Plains | Medicare|All Plans | $59.05 |
| United | Medicaid|Community Plan | $102 |
| Centene | Medicaid|NE Total Care | $104 |
| AMPS | Commercial|All Plans | $125 |
| Creighton University Employees | Commercial|All Plans | $239 |
| ELAP | Commercial|All Plans | $283 |
| Greater Omaha Packing | Commercial|Narrow Network | $351 |
| Millard Public Schools | Commercial|Narrow Network | $351 |
| One World | Commercial|Narrow Network | $351 |
| United | Commercial|All Plans | $371 |
| Medica | Commercial|Open Access | $381 |
| Midlands Choice | Commercial|Premier | $381 |
| Greater Omaha Packing | Commercial|Broad Network | $405 |
| Millard Public Schools | Commercial|Broad Network | $405 |
| One World | Commercial|Broad Network | $405 |
| Timpte | Commercial|Broad Network | $405 |
| Midlands Choice | Commercial|Standard | $449 |
Inpatient
$285cash price (self-pay)
$488list price
$229–$473range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $239 |
| United | Commercial|All Plans | $371 |
| Medica | Commercial|Open Access | $381 |
| Midlands Choice | Commercial|Premier | $381 |
| Midlands Choice | Commercial|Standard | $449 |
| MultiPlan PHCS | Commercial|All Plans | $454 |
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