CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Hamilton Memorial Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $731
  • Cash Discount Price: $809
  • vs. Medicare Baseline: 3.00x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Hamilton Memorial Hospital is $731. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $809. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.00x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.
Cash / Self-Pay
$809

Average discount available for prompt cash payment at this facility.

Insurance Median
$731

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: $809 (332%)
Insurance Median: $731 (300%)
Cash: $809 (332% of Medicare)
Ins. Median: $731 (300% 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 300% of the Medicare baseline (a markup of 200%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $172 - $857 71%
Blue Cross Blue Shield $172 - $866 71%
Health Alliance $172 - $761 71%
Medicare (plans) $172 - $381 71%
UnitedHealthcare $172 - $682 71%
Wellcare $172 - $381 71%
Medicaid / KanCare $354 - $381 145%
Humana $381 156%
Alliance Coal $666 273%
Healthscope $666 273%
Wellfirst (Ssmhic) $666 273%
Hope Trust $714 293%
Cigna $747 306%
Hfn, Inc $761 - $857 312%
Healthlink $809 - $857 332%
Multiplan $809 332%
Siho $857 352%
Three Rivers Provider $857 352%
Healthsmart $904 371%
Stratose $904 371%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 611 S Marshall Avenue, McLeansboro, IL 62859
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals