CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Pinckneyville Community Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $693
Cash Discount Price: $1,701
vs. Medicare Baseline: 2.84x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Pinckneyville Community Hospital is $693. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,701. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.84x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,701

Average discount available for prompt cash payment at this facility.

Insurance Median

$693

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: $1,701 (698%)

Insurance Median: $693 (284%)

Cash: $1,701 (698% of Medicare)

Ins. Median: $693 (284% 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 284% of the Medicare baseline (a markup of 184%). 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
Aetna	$33 - $1,685	14%
Humana	$33 - $693	14%
Umwa Mcr Adv - All Plans	$33 - $693	14%
UnitedHealthcare	$33 - $1,535	14%
Wellcare Mcr Adv - All Plans	$33 - $693	14%
Cigna	$39 - $1,544	16%
Blue Cross Blue Shield	$68 - $1,348	28%
Healthlink Hmo	$260 - $1,470	107%
Healthlink Ppo - All Other Plans	$260 - $1,544	107%
Phcs Savility	$357 - $1,591	146%
Multiplan - All Plans	$378 - $1,685	155%
Phcs - All Other Plans	$378 - $1,535	155%
Ambetter / Centene	$919	377%
Medicaid / KanCare	$919	377%
Healthlink Work Comp	$1,403 - $1,544	576%

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 $1,701.
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 Pinckneyville Community 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.