CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Monroe County Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $523
Cash Discount Price: $634
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Monroe County Hospital is $523. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $634. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.15x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$634

Average discount available for prompt cash payment at this facility.

Insurance Median

$523

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: $634 (260%)

Insurance Median: $523 (215%)

Cash: $634 (260% of Medicare)

Ins. Median: $523 (215% 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 215% of the Medicare baseline (a markup of 115%). 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
Wellmark Hmo	$217	89%
Wellmark Ppo - All Other Plans	$233	96%
Mahp Mcare - All Plans	$444	182%
Tricare	$444	182%
UnitedHealthcare	$444 - $1,003	182%
Va Ccn - All Plans	$444	182%
Amerigroup Mcare	$448	184%
Humana	$448	184%
Wellmark Mcare	$448	184%
Aetna	$452 - $993	185%
Iowa Total Care Mcaid - All Plans	$528	217%
Molina Mcaid - All Plans	$536	220%
Amerigroup Mcaid - All Other Plans	$543	223%
Centivo - All Plans	$665	273%
Midlands Choice - All Plans	$739	303%
Preferred Hlth - All Plans	$792	325%
Geha - All Plans	$845	347%
Multiplan - All Plans	$950	390%
Integrated Hp - All Plans	$1,024	420%

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 $634.
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 Monroe County 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.