CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: McLaren Macomb

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $136
Cash Discount Price: $224
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at McLaren Macomb is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $224. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.56x the Medicare baseline. Located in 1000 Harrington St, Mount Clemens, MI.

Cash / Self-Pay

$224

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $224 (92%)

Insurance Median: $136 (56%)

Cash: $224 (92% of Medicare)

Ins. Median: $136 (56% 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
Medicaid / KanCare	$20 - $139	8%
Humana	$32 - $236	13%
Medicare (plans)	$32 - $377	13%
U Of M Health Plan	$36	15%
Aetna	$39 - $497	16%
Mclaren Commercial Ins	$40 - $231	16%
UnitedHealthcare	$42 - $543	17%
Priority Health	$44 - $451	18%
Blue Cross Blue Shield	$51 - $321	21%
Tricare	$213	87%
Mi Amish Medical Board	$236	97%
Workers Compensation	$263	108%
Cofinity Group 15892 & 15893	$418	171%
Cofinity Auto	$448	184%

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 $224.
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 McLaren Macomb 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.