Ultrasound, leg veins (duplex)
Facility: Ashland Health Center
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $667
- Cash Discount Price: $534
- vs. Medicare Baseline: 2.74x 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 274% of the Medicare baseline (a markup of 174%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $223 | 91% |
| Compalliance-All Plans | $534 | 219% |
| Health Partners Of Kansas-All Plans | $567 | 233% |
| Multiplan-All Plans | $654 | 268% |
| Medicare (plans) | $667 | 274% |
| Aetna | $667 | 274% |
| Health Choice-All Plans | $667 | 274% |
| UnitedHealthcare | $667 | 274% |
| Healthy Blue Mcr Adv - All Other Plans | $667 | 274% |
| Medica Mcare - All Plans | $667 | 274% |
| Medicaid / KanCare | $667 | 274% |
| Providers Care (Wppa)-All Plans | $1,001 | 411% |
Consumer Guidance & Cost Commentary
For the ultrasound of leg veins (duplex) at Ashland Health Center in Ashland, KS, the facility's negotiated rates with major payers like Blue Cross Blue Shield and Compalliance-All Plans are $223 and $534, respectively. These amounts are significantly lower than the facility's gross charge of $667, reflecting standard insurance contracts that cap costs for members. While the cash median price is $534, which matches the negotiated rate for Compalliance-All Plans, patients with high-deductible plans might find paying the cash price directly more advantageous if their insurance allowed amount exceeds this figure. It is important to note that while the facility is a Critical Access Hospital in a rural setting, the specific data provided does not include comparative averages for the county or state, so direct regional comparisons cannot be made from this report.
The Medicare benchmark for this service is $243.77, which serves as a baseline for evaluating the facility's pricing structure. The median paid amount of $667 aligns with the gross charge and the negotiated rates for several major payers, including Medicare, Aetna, and UnitedHealthcare, indicating that for these specific plans, the allowed amount equals the full billed rate. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status before scheduling. Additionally, patients should request a prompt-pay discount or self-pay rate before check-in, as paying upfront can often reduce the final cost by bypassing administrative fees and insurance processing delays.