CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Elmhurst Hospital Center

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $789
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Elmhurst Hospital Center is $789. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.24x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$789

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%)

Insurance Median: $789 (324%)

Ins. Median: $789 (324% 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 324% of the Medicare baseline (a markup of 224%). 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
Healthfirst	$28 - $1,741	11%
Aetna	$30 - $1,171	12%
Amidacare	$35 - $774	14%
Emblem	$35 - $1,505	14%
Wellcare	$37 - $228	15%
Metroplus	$46 - $1,741	19%
Fidelis	$50 - $1,741	21%
Oscar	$52 - $1,396	21%
United	$198 - $1,794	81%
Oxford	$229 - $1,346	94%
Blue Cross Blue Shield	$286 - $1,794	117%
Elderplan	$286 - $1,458	117%
Vaccn	$286	117%
Vnsny	$286 - $1,907	117%
Centers Plan For Healthy Living	$297	122%
Cigna	$374 - $1,682	153%
Carelon	$758 - $1,458	311%
Senior Whole Health	$774	318%
United Behavioral Health	$774 - $851	318%
Affinity	$789 - $1,741	324%
Carelon (Amida Care)	$789	324%
Local 1199	$796 - $1,907	327%
Centerlight	$1,075 - $1,122	441%
Magnacare	$1,612 - $1,682	661%
Multiplan	$1,720 - $1,794	706%
Villagecare Max	$1,827 - $1,907	749%

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 $X.
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 Elmhurst Hospital Center 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.