Ultrasound, leg veins (duplex)
Facility: Bob Wilson Memorial Hospital
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $942
- Cash Discount Price: $461
- vs. Medicare Baseline: 3.86x 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 386% of the Medicare baseline (a markup of 286%). 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 |
|---|---|---|
| Centura Employee Plan | $293 | 120% |
| Kansas Health | $369 | 151% |
| UnitedHealthcare | $369 - $962 | 151% |
| Aetna | $369 - $923 | 151% |
| Medicare (plans) | $369 | 151% |
| Humana | $369 | 151% |
| Blue Cross Blue Shield | $642 | 263% |
| Multiplan | $1,038 - $1,073 | 426% |
| Health Partners Of Kansas | $1,084 | 445% |
| Wppa | $1,096 | 450% |
Consumer Guidance & Cost Commentary
For the CPT code 93970, representing an ultrasound of leg veins, the cash median price at Bob Wilson Memorial Hospital in Ulysses, KS, is $461.00. This cash rate is significantly lower than the facility's gross charge of $1,153.00 and notably below the negotiated rates paid by major payers such as UnitedHealthcare (up to $962) and Multiplan (up to $1,073). While the data does not provide a specific state or county average for this procedure, patients with high-deductible plans may find the cash price advantageous if their insurance negotiated rate exceeds $461.00, as paying out-of-pocket could result in immediate savings compared to the administrative costs and potential deductibles associated with insurance claims.
The facility's negotiated rates vary widely among payers, ranging from $293 for Centura Employee Plan to $1,096 for Wppa, reflecting the complex dynamics of commercial insurance contracts. It is important to note that these negotiated amounts represent the maximum allowed by insurers and do not necessarily reflect the final patient responsibility, which depends on individual plan deductibles and copays. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the bill. Additionally, if a patient receives care from an out-of-network provider at this facility, they may be subject to balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act offers protections for emergency and non-emergency services at in-network facilities.