CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Modoc Medical Center

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,128
Cash Discount Price: $1,235
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Modoc Medical Center is $1,128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,235. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.63x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$1,235

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,128

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,235 (507%)

Insurance Median: $1,128 (463%)

Cash: $1,235 (507% of Medicare)

Ins. Median: $1,128 (463% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 463% of the Medicare baseline (a markup of 363%). 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
Multiplan Wc	$232	95%
Adv Med Mgmt - All Plans	$241	99%
Medi-Cal	$241	99%
Medi-Cal 7/1/24	$241	99%
Ntwrks By Design Wc - All Plans	$241	99%
Integrated Hp Wc	$244	100%
Blue Shield Mcr Adv	$668	274%
Blue Shield Va	$668	274%
UnitedHealthcare	$668 - $1,173	274%
Tricare	$704	289%
Healthnet Mcr Adv	$711	292%
Partnership Hp - All Plans	$845	347%
Blue Cross Blue Shield	$1,015 - $1,128	416%
Blue Shield Exch	$1,015	416%
Blue Shield Comm - All Other Plans	$1,127	462%
Carelon - All Plans	$1,128	463%
Corvel - All Plans	$1,160	476%
Aetna	$1,173	481%
Coventry/First Health - All Plans	$1,173	481%
Galaxy Health - All Plans	$1,173	481%
Healthnet Comm - All Other Plans	$1,173	481%
Hmn - All Plans	$1,173	481%
Integrated Hp - All Other Plans	$1,173	481%
Interplan - All Plans	$1,173	481%
Multiplan - All Other Plans	$1,173	481%
Superior Ca Ppo - All Plans	$1,173	481%

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 $1,235.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 93970.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Modoc Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 93970.
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.