CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Monroe Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $445
Cash Discount Price: $251
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Monroe Hospital is $445. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $251. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.83x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$251

Average discount available for prompt cash payment at this facility.

Insurance Median

$445

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: $251 (103%)

Insurance Median: $445 (183%)

Cash: $251 (103% of Medicare)

Ins. Median: $445 (183% 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	$251	103%
Blue Cross Blue Shield	$251 - $740	103%
Care Source	$251 - $740	103%
Medicare (plans)	$251	103%
Tricare	$251	103%
UnitedHealthcare	$251 - $740	103%
Usa Senior Care Network	$251	103%
Worthington Christian Fellowship	$251	103%
Monroe Medical Group And Managed Health Services	$256 - $740	105%
Provider Partners Health Plan	$276	113%
Employer Direct Healthcare	$352	144%
Corvel Workers Compensation	$437	179%
Zelis Healthcare Fka Stratose	$477	196%
Americas Choice Provider Network Acpn	$487	200%
Multiplan	$487	200%
Prime Health Services	$487	200%
Three Rivers	$487	200%
Encore Health Network Workers Compensation	$492	202%
Provider Select	$497	204%
Provider Network Of America	$502	206%
Workers Compensation	$502	206%
Medicaid / KanCare	$740	304%

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 $251.
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 Monroe 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.