CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Rio Grande Regional Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,094
Cash Discount Price: $3,167
vs. Medicare Baseline: 4.49x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Rio Grande Regional Hospital is $1,094. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,167. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.49x the Medicare baseline. Located in 101 E Ridge Rd, McAllen, TX.

Cash / Self-Pay

$3,167

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,094

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: $3,167 (1299%)

Insurance Median: $1,094 (449%)

Cash: $3,167 (1299% of Medicare)

Ins. Median: $1,094 (449% 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 449% of the Medicare baseline (a markup of 349%). 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
Texas Health Network	$187	77%
Driscoll Children'S Health Plan	$194	80%
United	$196 - $1,425	80%
Aetna	$207 - $1,457	85%
Molina Healthcare	$208	85%
Superior Health Plan	$222	91%
Texas Athletic Network	$300 - $600	123%
Blue Cross Blue Shield	$695 - $1,425	285%
Texas Workforce Commission	$760	312%
Healthcare Highways	$808	331%
Oscar	$861	353%
Averde Health	$1,045	429%
Allegian Health	$1,267	520%
Curative Administrators	$1,267	520%
Cigna	$1,302 - $1,742	534%
Healthsmart Preferred Care	$1,362 - $2,692	559%
First Health	$1,821	747%
National Healthcare Solutions	$1,900	779%
Southwest Medical	$1,900	779%
Coastal Comp	$2,059	845%
Usa Managed Care	$2,059 - $2,534	845%
Humana	$2,130	874%
Ppo Next/ Medical Control	$2,375	974%
Beech Street	$2,534	1040%
Multiplan	$2,534	1040%

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 $3,167.
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 Rio Grande Regional 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.