EKG tracing at Froedtert Holy Family Memorial Hospital. CPT 93005.
What Froedtert Holy Family Memorial Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$110cash price (self-pay)
$200list price
$56.50–$251range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield | Medicare Advantage | $56.50 |
| Community Care Incorporated | Medicare Advantage | $56.50 |
| Health Partners | Medicare Advantage | $56.50 |
| Humana | Medicare Advantage | $56.50 |
| ICare | Medicare Advantage | $56.50 |
| Molina | Medicare Advantage | $56.50 |
| Network Health Plan | Medicare Advantage | $56.50 |
| Security Health Plan | Medicare Advantage | $56.50 |
| United Healthcare | Medicare Advantage | $56.50 |
| Allwell | Medicare Advantage | $57.63 |
| Molina | Marketplace Plans | $61.01 |
| Medical College of Wisconsin | Employee Plan | $66.00 |
| Centivo | WI 2 Median | $80.00 |
| Centivo | WI 1 Broad | $92.00 |
| Dean Health Plan | All Plans | $100 |
| Health Payment Systems | All Contracted Commercial Plans | $113 |
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $120 |
| Chorus Community Health Plan | Marketplace Plans | $129 |
| Health Partners | All Contracted Commercial Plans | $130 |
| Trilogy | All Contracted Commercial Plans | $132 |
| Cigna | All Contracted Commercial Plans | $144 |
| WPS Health Plan | All Contracted Commercial Plans | $148 |
| Network Health Plan | ACA | $151 |
| Aspirus | Marketplace Plans | $160 |
| HealthEos | All Contracted Commercial Plans | $160 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $160 |
| Preferred One | All Contracted Commercial Plans | $160 |
| Security Health Plan | All Contracted Commercial Plans | $160 |
| HealthSmart | All Contracted Commercial Plans | $166 |
| United Healthcare | Manitowoc Schools | $167 |
Inpatient
$110cash price (self-pay)
$200list price
$120–$176range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $120 |
| Trilogy | All Contracted Commercial Plans | $132 |
| Cigna | All Contracted Commercial Plans | $144 |
| Aspirus | Marketplace Plans | $160 |
| HealthEos | All Contracted Commercial Plans | $160 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $160 |
| Preferred One | All Contracted Commercial Plans | $160 |
| Security Health Plan | All Contracted Commercial Plans | $160 |
| HealthSmart | All Contracted Commercial Plans | $166 |
| First Health Network | All Contracted Commercial Plans | $176 |
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All common services at Froedtert Holy Family Memorial Hospital