CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Adena Pike Medical Center

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,550
Cash Discount Price: $1,028
vs. Medicare Baseline: 6.36x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Adena Pike Medical Center is $1,550. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,028. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.36x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$1,028

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,550

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: $1,028 (422%)

Insurance Median: $1,550 (636%)

Cash: $1,028 (422% of Medicare)

Ins. Median: $1,550 (636% 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 636% of the Medicare baseline (a markup of 536%). 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
Aetna	$494 - $1,674	203%
Blue Cross Blue Shield	$494 - $1,775	203%
Buckeye Community Health Plan	$494	203%
Humana	$494 - $1,954	203%
Medical Mutual Of Ohio	$494 - $1,307	203%
Medigold	$494	203%
Molina	$494	203%
Care Source	$503	206%
Gateway Health	$679	279%
Molina Marketplace	$809	332%
Care Source Just4Me	$888	364%
Sidecar Health	$1,357	557%
Ohio Ppo Connect	$1,440	591%
The Health Plan	$1,440	591%
Cigna	$1,489	611%
Medical Mutual Of Ohio Supermed	$1,550	636%
First Health	$1,612	661%
Ohio Health Choice	$1,637	672%
UnitedHealthcare	$1,769	726%
Integrated Health Plan	$1,933	793%
Healthsmart	$1,954	802%
Multiplan/Private Healthcare Systems	$1,954	802%
Three Rivers Network	$1,954	802%

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 $1,028.
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 Adena Pike Medical 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.