Ultrasound, leg veins (duplex)
Facility: Decatur Health
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $681
- Cash Discount Price: $803
- vs. Medicare Baseline: 2.79x 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 279% of the Medicare baseline (a markup of 179%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $536 | 220% |
| UnitedHealthcare | $545 - $681 | 224% |
| Humana | $550 | 226% |
| Blue Cross Blue Shield | $619 | 254% |
| Midlands Choice- All Plans | $803 | 329% |
| Aetna | $803 - $893 | 329% |
| Medicaid / KanCare | $902 | 370% |
Consumer Guidance & Cost Commentary
For this ultrasound of leg veins (duplex) at Decatur Health in Oberlin, Kansas, the cash price is $803.00, which serves as a strong benchmark for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $545 to $893, the cash price is often lower than these insurance allowed amounts, meaning self-pay patients could save money by paying directly. It is important to note that Medicaid/KanCare has a fixed rate of $902.00, which exceeds the cash price, and the facility's cash rate is significantly higher than the national average for this procedure. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final cost further.
When reviewing your bill, be aware that commercial insurance rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $243.77. Although the facility's cash rate is higher than the Medicare amount, it remains below the gross chargemaster price of $893.00, indicating a substantial discount from the list price. If you receive a bill that includes unexpected charges or only broad category totals, you should request a full itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. Additionally, if you are an out-of-network patient, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services