CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Lodi Community Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $675
Cash Discount Price: $820
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Lodi Community Hospital is $675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $820. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.77x the Medicare baseline. Located in 225 Elyria Street, Lodi, OH.

Cash / Self-Pay

$820

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: $820 (336%)

Insurance Median: $675 (277%)

Cash: $820 (336% 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
UnitedHealthcare	$175 - $782	72%
Buckeye	$185	76%
Caresource	$185	76%
Blue Cross Blue Shield	$194 - $1,032	80%
Molina	$194	80%
United	$194 - $900	80%
Amerihealth	$203	83%
Humana	$378	155%
Mmo	$378 - $675	155%
Summacare	$378 - $773	155%
Oscar	$380 - $485	156%
Aetna	$429 - $1,261	176%
The Health Plan	$504 - $1,009	207%
Amish Community Aid Plan	$567 - $630	233%
Ohcp	$613	251%
Aultcare	$630	258%
Omas	$630	258%
Ohio Healthy	$681	279%
Php	$757	311%
Phphi	$757	311%
Upmc	$757	311%
Cigna	$813	334%
Cc Ehp	$847	347%
Gms	$883	362%
Medical Benefit Corp	$883	362%
Consociate Health	$946	388%
Frontpath	$1,135	466%
Managed Care Services	$1,135	466%
Multiplan	$1,135	466%
Tertiary Care Network	$1,135	466%

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 $820.
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 Lodi Community 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.