CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $390
Cash Discount Price: $469
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Iowa Specialty Hospital - Clarion is $390. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $469. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.60x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$469

Average discount available for prompt cash payment at this facility.

Insurance Median

$390

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: $469 (192%)

Insurance Median: $390 (160%)

Cash: $469 (192% of Medicare)

Ins. Median: $390 (160% 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
Tricare	$30 - $419	12%
Triwest Va - All Plans	$30 - $419	12%
Aetna	$33 - $1,150	14%
Healthscope Stellar-All Plans	$50 - $714	21%
UnitedHealthcare	$59 - $1,285	24%
Health Partners Ish-All Other Plans	$60 - $1,082	25%
Wellmark Hmo	$60 - $395	25%
Wellmark Ppo - All Other Plans	$67 - $434	27%
Auxiant Clarion Schools-All Plans	$137 - $879	56%
Health Partners Prestage	$158 - $1,015	65%
Cigna	$385 - $1,312	158%
Midlands Choice-All Plans	$385 - $1,312	158%

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 $469.
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 Iowa Specialty Hospital - Clarion 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.