EKG tracing at Intermountain Health Good Samaritan Medical Center. CPT 93005.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$552list price
$21.63–$495range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $102 |
| Aetna | Aetna Colorado Preferred | $113 |
| Aetna | Aetna HMO/EPO | $122 |
| Aetna | Aetna Indemnity | $122 |
| Aetna | Aetna Other | $122 |
| Aetna | Aetna POS/Qpos | $122 |
| Aetna | Aetna PPO | $122 |
| Aetna | Aetna Src | $122 |
| Geha | Geha-Asa | $122 |
| Preferred One | Preferred One | $122 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $127 |
| Kaiser Perm HMO | Kaiser Out Of State | $127 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $127 |
| Allegiance | Cigna Sclhs Employees | $138 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $138 |
| Cigna | Cigna Co Public Option | $140 |
| Cigna | Cigna Connect Exchange | $140 |
| Cigna | Cigna Surefit | $140 |
| BCBS/Anthem | BCBS Co Federal | $220 |
| BCBS/Anthem | BCBS Co HMO | $220 |
| BCBS/Anthem | BCBS Co PPO | $220 |
| Choicecare Humana | Choicecare Humana HMO EPO | $232 |
| Choicecare Humana | Choicecare Humana PPO | $232 |
| Cigna | Cigna HMO | $316 |
| Cigna | Cigna Indemnity | $316 |
| Cigna | Cigna Local Plus | $316 |
| Cigna | Cigna Other | $316 |
| Cigna | Cigna POS/Qpos | $316 |
| Cigna | Cigna PPO | $316 |
| Cigna | Eighth Dist Elect Ben Pln | $316 |
Inpatient
—cash price (self-pay)
$552list price
$163–$552range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $163 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $232 |
| Kaiser Perm HMO | Kaiser Out Of State | $232 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $232 |
| Kaiser Self Funded | Kaiser Self Funded | $232 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $239 |
| Private Hlthcare Sys | Phcs Other | $414 |
| Private Hlthcare Sys | Phcs PPO | $414 |
| BCBS/Anthem | BCBS Co Indemnity | $464 |
| Multiplan Inc | Multiplan Inc Other | $469 |
| Multiplan Inc | Multiplan Inc PPO | $469 |
| Aetna | Aetna Nap | $495 |
| Cigna | Cigna HMO | $552 |
| Cigna | Cigna Indemnity | $552 |
| Cigna | Cigna Local Plus | $552 |
| Cigna | Cigna Other | $552 |
| Cigna | Cigna POS/Qpos | $552 |
| Cigna | Cigna PPO | $552 |
| Cigna | Eighth Dist Elect Ben Pln | $552 |
| Cigna | Health-Partners | $552 |
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All common services at Intermountain Health Good Samaritan Medical Center