Ultrasound, leg veins (duplex)
Facility: Golden Valley Memorial Hospital
Billing Code: 93970 (CPT)
- CPT Billing Code: 93970
- Insurance Median: $243
- Cash Discount Price: $773
- vs. Medicare Baseline: 1.00x 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.
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 |
|---|---|---|
| Home State Health | $219 | 90% |
| UnitedHealthcare | $219 - $413 | 90% |
| Aetna | $243 | 100% |
| Humana | $243 | 100% |
| Ambetter / Centene | $291 | 119% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important detail to know is that the facility's cash rate for this ultrasound procedure is $773. While this serves as a baseline for self-pay patients, it is significantly higher than the facility's median negotiated rate of $243, which represents the amount insurance plans like Home State Health, UnitedHealthcare, Aetna, Humana, and Ambetter / Centene typically pay. Because insurance contracts often include administrative overheads and multi-layered billing structures, the negotiated rate can sometimes exceed the cash price; however, in this specific instance, the cash option is the lower-cost choice for those without insurance or with high-deductible plans where out-of-pocket costs would otherwise be substantial.
When comparing this facility's pricing to broader market standards, the cash rate of $773 is notably higher than the state of Missouri's average for this procedure, which sits at $243.77. Furthermore, the facility's cash charge is more than double the median negotiated rate of $243 observed across the region. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it does not automatically apply to self-pay scenarios or prevent hospitals from billing the full chargemaster price before offering discounts. To ensure you are receiving the most accurate and potentially reduced pricing, it is advisable to contact Golden Valley Memorial Hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these arrangements can sometimes lower the final bill below the published cash rate.