CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Anderson Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,374
Cash Discount Price: $1,291
vs. Medicare Baseline: 5.64x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Anderson Hospital is $1,374. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,291. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.64x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$1,291

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,374

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: $1,291 (530%)

Insurance Median: $1,374 (564%)

Cash: $1,291 (530% of Medicare)

Ins. Median: $1,374 (564% 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 564% of the Medicare baseline (a markup of 464%). 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
Tricare	$167 - $5,706	69%
Humana	$172 - $4,785	71%
Medicare (plans)	$172 - $4,785	71%
UnitedHealthcare	$172 - $4,785	71%
Medicaid / KanCare	$176 - $211	72%
Health Care Service Corporation	$178 - $1,182	73%
Aetna	$252 - $4,785	103%
Essence	$256 - $5,028	105%
Devoted Health Ppo	$257 - $4,881	105%
Clear Springs Health	$259 - $4,929	106%
Work Comp	$340 - $26,600	139%
Ambetter / Centene	$371 - $7,079	152%
Blue Choice	$371 - $7,079	152%
Hopetrust	$639 - $12,205	262%
Self Pay	$1,291 - $25,000	530%
Blue Cross Blue Shield	$1,385 - $1,435	568%
Healthlink	$1,601 - $1,808	657%
Cigna	$1,679	689%
Mercy Aco	$1,679	689%
Mercy Benefit Admin	$1,679	689%
Multiplan/Phcs	$1,937	795%
Beech Street Corporation	$2,325	954%

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 $1,291.
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 Anderson 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.