Ultrasound, leg veins (duplex)
Facility: Nmc Health
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $523
- Cash Discount Price: $610
- vs. Medicare Baseline: 2.15x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 215% of the Medicare baseline (a markup of 115%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Bluestem Pace | $225 | 92% |
| Leading Age | $361 | 148% |
| Medicaid / KanCare | $361 | 148% |
| Aetna | $433 - $719 | 178% |
| Wppa | $480 | 197% |
| Blue Cross Blue Shield | $481 | 197% |
| Occunet | $523 | 215% |
| Medincrease Health Plan | $567 | 233% |
| Samaritan Ministries International | $567 | 233% |
| Prime Health Services | $654 | 268% |
| UnitedHealthcare | $785 | 322% |
| Cigna | $828 | 340% |
Consumer Guidance & Cost Commentary
For the ultrasound of leg veins (duplex) at Nmc Health in Newton, Kansas, the facility's cash price of $610.00 is notably lower than the gross charge of $872.00, offering a potential savings for patients with high-deductible plans. While the facility's negotiated rates with commercial payers range from $225 to $828, the cash price remains the most consistent baseline for self-pay patients. It is important to note that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures, meaning paying out-of-pocket can sometimes be the most economical option if your insurance deductible has not yet been met. Patients should verify their specific plan's allowed amount before scheduling, as some in-network rates may still be higher than the cash rate.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $243.77. Commercial negotiated rates typically average between 200% and 300% of this Medicare baseline, whereas fair pricing is generally defined as 120% to 150%. The facility's cash price of $610.00 represents a significant markup over the Medicare rate, reflecting the standard pricing dynamics in the Acute Care Hospitals sector in KS. To maximize savings, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront. Additionally, requesting a detailed, itemized bill is recommended to ensure no errors or unbundled charges are included before finalizing payment.