CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Clay County Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $172
Cash Discount Price: $1,283
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Clay County Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,283. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.71x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$1,283

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $1,283 (526%)

Insurance Median: $172 (71%)

Cash: $1,283 (526% of Medicare)

Ins. Median: $172 (71% 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
Aetna	$22 - $1,014	9%
Blue Cross Blue Shield	$22 - $942	9%
Meridian	$22 - $346	9%
Molina	$22 - $120	9%
Ambetter / Centene	$33 - $346	14%
Medica(Wellfirst)	$33 - $795	14%
UnitedHealthcare	$33 - $1,026	14%
Wellcare	$33 - $346	14%
Healthlink	$270 - $1,026	111%
Cigna	$333 - $1,026	137%
Usa Mco	$395 - $1,219	162%

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 $1,283.
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 Clay County 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.