CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Kootenai Health

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $209
Cash Discount Price: $898
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Kootenai Health is $209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $898. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.86x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$898

Average discount available for prompt cash payment at this facility.

Insurance Median

$209

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: $898 (368%)

Insurance Median: $209 (86%)

Cash: $898 (368% of Medicare)

Ins. Median: $209 (86% 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
Coordinated Care Of Washington	$20 - $116	8%
Molina Healthcare Of Idaho	$20 - $443	8%
Molina Healthcare Of Washington	$20 - $116	8%
Blue Cross Blue Shield	$30 - $1,077	12%
Humana	$30 - $247	12%
Magellan	$30 - $165	12%
Premera	$30 - $740	12%
Regence Blue Shield Of Idaho	$30 - $247	12%
UnitedHealthcare	$30 - $1,077	12%
Wellpoint	$30 - $165	12%
Pacificsource	$31 - $980	13%
Aetna	$32 - $994	13%
Group Health/Kaiser	$45 - $888	18%
Mountain Health Co-Op	$928	381%
Cigna	$980 - $995	402%
Interwest Health	$1,017	417%
First Choice Health (Ameriben)	$1,021 - $1,037	419%

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 $898.
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 Kootenai Health 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.