CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Central Florida Lake Monroe Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,018
Cash Discount Price: $3,845
vs. Medicare Baseline: 4.18x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Central Florida Lake Monroe Hospital is $1,018. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,845. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.18x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$3,845

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,018

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: $3,845 (1577%)

Insurance Median: $1,018 (418%)

Cash: $3,845 (1577% of Medicare)

Ins. Median: $1,018 (418% 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 418% of the Medicare baseline (a markup of 318%). 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
Corvel Corporation	$162 - $967	66%
Prime Health	$165 - $988	68%
Careworks (Rockport Community)	$170 - $1,018	70%
Freedom Health	$277	114%
Optimum	$277	114%
Simply	$592	243%
Oscar	$615	252%
Simply Healthcare	$642	263%
Cigna	$669	274%
Molina Healthcare	$730 - $1,230	299%
Humana	$769	315%
Evolutions	$884	363%
Avmed	$923 - $1,922	379%
Sunshine State Health Plan	$980	402%
Aetna	$1,153	473%
United	$1,284 - $1,730	527%
Florida Health Care Plan	$1,449	594%
Plotkin Health	$1,922	788%
Prime Health Sheriff	$1,922	788%
Multiplan	$2,884 - $3,268	1183%
Three Rivers Provider Network	$2,884	1183%
Ppo Next	$3,268	1341%
Novanet	$3,460	1419%

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 $3,845.
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 Central Florida Lake Monroe Hospital 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.