CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Sanford Sheldon Medical Center

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,079
Cash Discount Price: $1,338
vs. Medicare Baseline: 4.43x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Sanford Sheldon Medical Center is $1,079. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,338. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.43x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$1,338

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,079

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: $1,338 (549%)

Insurance Median: $1,079 (443%)

Cash: $1,338 (549% of Medicare)

Ins. Median: $1,079 (443% 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 443% of the Medicare baseline (a markup of 343%). 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
Sanford Health Plan Align	$477	196%
Ucare	$512 - $1,469	210%
Aetna	$517 - $1,453	212%
Blue Cross Blue Shield	$517	212%
Health Partners	$517 - $1,254	212%
Medicare (plans)	$517	212%
UnitedHealthcare	$517 - $1,396	212%
Primewest	$527	216%
Wellmark	$836 - $869	343%
Sanford Health Plan	$896 - $1,054	368%
Security Health Plan	$920	377%
Medica	$1,379 - $1,475	566%
First Choice Health Network	$1,505	617%
Healthez	$1,505	617%
Multiplan	$1,505	617%

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 $1,338.
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 Sanford Sheldon 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.