CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 93880

Carotid Ultrasound (Extracranial Bilateral Study)

CPT 93880 is a duplex ultrasound of both carotid arteries in your neck, used to detect plaque buildup and blockages that can lead to stroke. Providers charge an average of $519.47 for this test, but Medicare pays $189.05 in an office (freestanding lab) setting. In a hospital facility, the physician fee drops to just $34.74, but the hospital adds a separate facility fee on top, often making it more expensive overall.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 93880 at a Glance

Average provider charge: $519.47
Medicare physician fee (office): $189.05
Medicare physician fee (hospital): $34.74 + separate facility fee
Typical markup: 2.7x over Medicare office rate

What it detects: Carotid plaque, stenosis, blockages
Study type: Duplex (B-mode + Doppler), bilateral
Beneficiaries (2023): 984,504
USPSTF screening grade: D (not recommended for asymptomatic adults)

How the Medicare Rate Is Calculated

Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). The carotid ultrasound has a very high practice expense in the office setting because it requires expensive ultrasound equipment and a trained vascular technologist.

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time, skill, and judgment	0.70	0.70
Practice Expense RVU	Equipment, technologist, supplies	4.48	0.29
Malpractice RVU	Professional liability insurance	0.05	0.05
Total RVU		5.23	1.04
x $33.4009	2026 conversion factor	$189.05	$34.74

Why freestanding vascular labs are so much cheaper: Notice the massive difference in practice expense RVU (4.48 vs 0.29). In an office/freestanding lab, the practice expense covers the ultrasound equipment and technologist. In a hospital, those costs are billed separately as a facility fee (typically $200 to $500). The combined hospital cost (physician $34.74 + facility fee) almost always exceeds the freestanding lab's all-inclusive $189.05.

Medicare Rate by State

Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). Because most of the RVU value is in practice expense (equipment and staff), states with higher real estate and labor costs see a larger difference.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$147.34	$519.47	3.5x
California (Los Angeles)	$159.36	$519.47	3.3x
New York (Manhattan)	$158.01	$519.47	3.3x
Florida (Fort Lauderdale)	$151.29	$519.47	3.4x
Ohio	$136.10	$519.47	3.8x
Mississippi	$129.61	$519.47	4.0x
Arkansas	$128.22	$519.47	4.1x
Alaska	$182.85	$519.47	2.8x

Rates shown are for the non-facility (office/freestanding lab) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $519.47 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

Who Actually Needs a Carotid Ultrasound?

This is critical information that could save you $519: the U.S. Preventive Services Task Force (USPSTF) gives routine carotid artery screening in asymptomatic adults a grade of "D," meaning the harms outweigh the benefits. Despite this, some "executive health" programs and screening services market carotid ultrasounds to healthy people.

When It Is Appropriate

You had a transient ischemic attack (TIA) or stroke
Your doctor heard a carotid bruit (abnormal whooshing sound) during a physical exam
You have known carotid stenosis being monitored over time
Pre-surgical evaluation before cardiac or vascular surgery

When It Is Likely Unnecessary

No symptoms, no history of TIA or stroke
Offered as part of a "wellness screening package"
Marketed by mobile screening companies at community events
Ordered solely because you have general cardiovascular risk factors (high blood pressure, diabetes) without symptoms

The cascade risk: An abnormal carotid ultrasound result (even a false positive) can lead to CT angiography ($500 to $1,500), MR angiography ($1,000 to $3,000), or carotid endarterectomy surgery ($20,000 to $50,000). For asymptomatic patients, this cascade of testing and intervention may cause more harm than benefit, which is why the USPSTF recommends against routine screening.

What Insured Patients Actually Pay for a Carotid Ultrasound

If you have insurance and the test is medically indicated, your cost depends on your plan design and whether you have met your deductible:

Your Situation	What You Likely Pay	How It Works
Copay plan (deductible met)	$50 to $150	Specialist or diagnostic test copay
Coinsurance plan (deductible met)	$45 to $95	20% of negotiated rate ($225 to $475)
High-deductible plan (deductible NOT met)	$225 to $475	Full negotiated rate applied to your deductible
Medicare Part B	$37.81	20% of the Medicare-approved amount ($189.05)
Not medically indicated (screening)	$300 to $519	Insurance may deny the claim entirely

Coverage depends on medical necessity. Insurance companies follow USPSTF guidelines closely. If you get a carotid ultrasound without documented symptoms or medical indication, your insurer may deny the claim as "not medically necessary," leaving you responsible for the full charge. Always confirm coverage before the test.

Common Billing Problems with CPT 93880

Facility fee surprise at hospital-owned vascular labs

Many vascular labs that look like independent offices are actually owned by hospital systems. The physician fee is only $34.74 in the facility setting, but the hospital adds a facility fee of $200 to $500 for the technical component. Your total out-of-pocket can be 2 to 3 times higher than at a truly independent freestanding vascular lab. Ask before scheduling: "Is this a hospital outpatient department or a freestanding facility?"

Bilateral billed as two separate unilateral studies

CPT 93880 covers a bilateral study (both sides). Some facilities incorrectly bill 93882 (unilateral) twice instead of 93880 once. Two unilateral studies (93882 x 2) costs more than one bilateral study. If your bill shows two charges for carotid ultrasound, verify that the correct bilateral code was used.

Denial for lack of medical necessity

If the ordering physician did not document a clear medical indication (symptoms, physical exam findings, or history), insurance may deny the claim. You receive the denial letter and may be balance-billed for the full amount. If this happens, ask your doctor to provide a letter of medical necessity or appeal the denial with supporting documentation.

Add-on codes for transcranial Doppler

Some facilities add a transcranial Doppler study (CPT 93886, $200 to $400 additional) during the same visit without clearly explaining it was a separate billable procedure. If you only consented to a carotid ultrasound and see additional vascular study charges, question whether the extra test was discussed and necessary.

How to Save on a Carotid Ultrasound

Use a freestanding vascular lab

Freestanding (non-hospital) vascular labs charge $150 to $300 for a carotid duplex study. Hospital outpatient departments charge $400 to $800 for the same test. The equipment and technologist training are identical. Ask your referring physician if a freestanding lab is available in your area.

Ask for the cash-pay rate upfront

If your deductible is not met, the cash-pay rate at a freestanding vascular lab ($150 to $250) may be lower than the negotiated insurance rate applied to your deductible. Call ahead and ask for the self-pay price.

Confirm medical necessity before the test

If your doctor orders this test, ask: "What is the clinical indication?" If the answer is general screening or "just to check," and you have no symptoms, consider whether you want a $519 test that guidelines recommend against. You have the right to decline a test.

Frequently Asked Questions

How much does a carotid ultrasound (CPT 93880) cost without insurance?

Without insurance, a carotid ultrasound costs $300 to $800 at hospitals and $150 to $300 at freestanding vascular labs. The national average charge is $519.47. Medicare pays $189.05 for this test in an office setting. If you are paying out of pocket, a freestanding vascular lab will be significantly cheaper than a hospital outpatient department.

Is a carotid ultrasound covered by insurance?

Insurance covers a carotid ultrasound when it is medically necessary. You typically need documented symptoms (TIA, stroke, carotid bruit) or a specific clinical indication. Routine screening of asymptomatic adults is not recommended by the USPSTF and may be denied by insurance. Always verify coverage with your insurer before the test.

Why is the carotid ultrasound so much cheaper at a freestanding vascular lab?

At a freestanding lab, Medicare pays one bundled rate of $189.05 that covers the physician interpretation and the technical component (equipment, technologist). At a hospital, the physician gets only $34.74, and the hospital bills a separate facility fee (often $200 to $500). The hospital's combined charges almost always exceed the freestanding lab's single fee.

Should I get a carotid ultrasound if I have no symptoms?

For most people without symptoms, no. The U.S. Preventive Services Task Force recommends against screening for carotid artery stenosis in asymptomatic adults (grade D). The test can produce false positives that lead to unnecessary invasive procedures. If you have had a TIA, stroke, or your doctor heard a bruit during examination, the test is appropriate and indicated.

Need Help Lowering a Medical Bill?

CareRoute Bill Defense is a done-for-you bill reduction service. We analyze the codes on your bill, identify overcharges and coding errors, and apply negotiation and reduction strategies on your behalf. If you received a carotid ultrasound bill that seems too high, we can help.

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