CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $198
Cash Discount Price: $1,016
vs. Medicare Baseline: 0.81x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Shriners Hospitals for Children Northern Calif is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,016. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.81x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$1,016

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $1,016 (417%)

Insurance Median: $198 (81%)

Cash: $1,016 (417% of Medicare)

Ins. Median: $198 (81% 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.

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
Gateway Health Plan	$147	60%
Amerigroup Nv	$151	62%
Soonercare	$151	62%
Ambetter / Centene	$168 - $356	69%
Health Plan Of Nv	$168	69%
Blue Cross Blue Shield	$189 - $193	78%
Aetna	$193 - $310	79%
Central California Alliance For Health	$193	79%
Health Plan Of San Joaquin	$193	79%
Kaiser Permanente	$193	79%
Molina Healthcare Of Ca	$193	79%
Partnership Healthplan Of Ca	$193	79%
Medicaid / KanCare	$198	81%
Molina Healthcare Of Ms	$234	96%
Amerihealth Caritas Nc	$269	110%
Amerihealth Caritas Sc	$269	110%
Caresource Of Oh	$269	110%
Cigna	$282	116%
Northbay Healthcare	$310	127%
Sana Benefits	$327 - $434	134%
Sutter Medical Foundation	$341	140%
Health Net Of Ca	$356	146%
Healthchoice Of Oklahoma	$411	169%

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 $1,016.
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 Shriners Hospitals for Children Northern Calif 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.