Ultrasound, leg veins (duplex)
Facility: Hodgeman County Health Center
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $566
- Cash Discount Price: $643
- vs. Medicare Baseline: 2.32x 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 232% of the Medicare baseline (a markup of 132%). 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 | $457 - $481 | 187% |
| Humana | $515 | 211% |
| Medicaid / KanCare | $515 - $804 | 211% |
| UnitedHealthcare | $515 - $764 | 211% |
| Triwest - All Plans | $515 | 211% |
| Aetna | $643 | 264% |
| First Health - All Plans | $724 | 297% |
| Wppa (Provdrscare) - All Plans | $764 | 313% |
| Health Partners - All Plans | $764 | 313% |
Consumer Guidance & Cost Commentary
For the CPT code 93970, representing an ultrasound of leg veins, the Hodgeman County Health Center in Jetmore, KS, lists a cash median price of $643.00, which matches the facility's negotiated rate for Aetna. This cash price is notably higher than the state average for this procedure, which is approximately $243.77 based on Medicare benchmarking. While commercial insurance plans like Blue Cross Blue Shield and Humana negotiate rates ranging from $457 to $804, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $643.00. It is important to note that while the facility is a Critical Access Hospital owned by the local government, patients should always verify specific "self-pay" or "prompt-pay" discounts with the billing department before scheduling, as these upfront incentives can significantly reduce the final out-of-pocket cost.
The data indicates that the facility's gross charge for this service is $804.00, but the median amount paid by insurers across nine payers is $605.00, with negotiated rates averaging $566.00. This disparity highlights the complexity of commercial billing, where administrative costs and contract dynamics often result in rates higher than the cash option. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still request an itemized bill to ensure no unbundled codes or services not rendered are included. If a patient receives a summary bill, they should demand a detailed line-by-line statement to identify any errors, as over