CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $265
Cash Discount Price: $1,053
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Munson Healthcare Otsego Memorial Hospital is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,053. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.09x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$1,053

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,053 (432%)

Insurance Median: $265 (109%)

Cash: $1,053 (432% of Medicare)

Ins. Median: $265 (109% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Mclaren Health Plan	$20 - $1,183	8%
Meridian	$20 - $124	8%
Molina	$20 - $257	8%
Priority Health	$20 - $352	8%
UnitedHealthcare	$20 - $1,130	8%
Blue Cross Blue Shield	$21 - $881	9%
Aetna	$32 - $1,143	13%
Blue Care Network	$32 - $238	13%
Hap (Health Alliance Plan)	$32 - $1,129	13%
Humana	$32 - $238	13%
Medicare (plans)	$32 - $238	13%
Michigan Amish Medical Board	$32 - $238	13%
Northern Michigan Mennonite Group	$32 - $238	13%
Cigna	$44 - $352	18%
Asr Physicians Care Network	$48 - $1,129	20%
Nomi Health	$51 - $1,129	21%
Employee Benefit Logistics	$54 - $404	22%
Hospice Of Michigan	$711 - $847	292%
Munson Hospice	$830 - $988	340%
Enterprise Group Planning/Employee Benefit Plan	$948 - $1,129	389%
Cofinity	$1,007 - $1,199	413%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$1,007 - $1,199	413%
Three Rivers Provider Network	$1,007 - $1,199	413%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,053.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 93970.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Munson Healthcare Otsego Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 93970.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.