CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Lexington Memorial Hospital Inc

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $675
Cash Discount Price: $765
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Lexington Memorial Hospital Inc is $675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $765. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.77x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$765

Average discount available for prompt cash payment at this facility.

Insurance Median

$675

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: $765 (314%)

Insurance Median: $675 (277%)

Cash: $765 (314% of Medicare)

Ins. Median: $675 (277% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 277% of the Medicare baseline (a markup of 177%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerihealth	$288 - $420	118%
Carolina Complete	$288	118%
Healthy Blue	$288	118%
Partners	$288	118%
UnitedHealthcare	$291 - $685	119%
Vaya	$291	119%
Wellcare	$291	119%
Alliance	$294	121%
Trillium	$297	122%
Medcost	$335 - $1,023	137%
Blue Cross Blue Shield	$381 - $610	156%
Aetna	$434 - $1,413	178%
Ambetter / Centene	$439	180%
Oscar	$489 - $673	201%
Cigna	$665 - $677	273%
Directnet	$904	371%
Healthgram Lexington Home Brands	$1,101	452%
Healthgram	$1,223	502%
Private Healthcare Systems	$1,254	514%
Beechstreet	$1,346	552%
Humana	$1,346	552%
Multiplan	$1,376	564%
National Provider Network	$1,376	564%

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 $765.
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 Lexington Memorial Hospital Inc 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.