Ultrasound, leg veins (duplex)
Facility: Mcpherson Hospital
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $883
- Cash Discount Price: $933
- vs. Medicare Baseline: 3.62x 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 362% of the Medicare baseline (a markup of 262%). 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 |
|---|---|---|
| Tricare | $27 - $193 | 11% |
| Blue Cross Blue Shield | $30 - $219 | 12% |
| Aetna | $30 - $1,470 | 12% |
| Healthy Blue Mcr Adv | $30 - $219 | 12% |
| Ambetter / Centene | $30 - $252 | 12% |
| UnitedHealthcare | $30 - $1,470 | 12% |
| Wellcare Mcr Adv - All Plans | $30 - $219 | 12% |
| Humana | $30 - $219 | 12% |
| Va Ccn - All Plans | $30 - $219 | 12% |
| Multiplan - All Plans | $38 - $1,323 | 16% |
| Medicaid / KanCare | $183 - $1,470 | 75% |
| Health Blue Mcaid - All Other Plans | $186 - $1,499 | 76% |
| Central Plains - All Plans | $242 - $1,102 | 99% |
| Medical Associates - All Plans | $242 - $1,102 | 99% |
| Health Partners - All Plans | $306 - $1,396 | 126% |
| Cigna | $306 - $1,396 | 126% |
| Wppa - All Plans | $883 - $1,029 | 362% |
| Christian Health Aid - All Plans | $1,009 - $1,176 | 414% |
| First Health - All Plans | $1,198 - $1,396 | 491% |
Consumer Guidance & Cost Commentary
For the CPT code 93970, representing an ultrasound of leg veins, McPherson Hospital in Kansas lists a gross charge of $1,261.00. While the facility's cash median rate is $933.00 and the median negotiated rate across payers is $883.00, these figures are significantly higher than the Medicare benchmark of $243.77. Under Medicare benchmarking principles, commercial rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. In this case, the cash and negotiated rates exceed the fair pricing range, suggesting that patients with high-deductible plans might save money by paying the cash price directly, provided they verify that their insurance negotiated rate does not exceed $933.00.
Patients should be aware that insurance contracts create a ceiling on what in-network members pay, but these rates can still be inflated by administrative costs and contract dynamics. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to confirm that the facility is truly in-network for your specific plan to avoid unexpected costs. Additionally, many hospitals offer prompt-pay discounts of 20% to 50% for upfront payment, which can further reduce the final bill. Before scheduling, we recommend contacting McPherson Hospital directly to inquire about self-pay or prompt-pay discounts and to ensure your specific insurance plan is covered for this procedure.