CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $1,621
  • Cash Discount Price: $1,297
  • vs. Medicare Baseline: 6.65x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at HSHS St Elizabeth's Hospital is $1,621. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,297. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.65x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$1,297

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,621

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: $1,297 (532%)
Insurance Median: $1,621 (665%)
Cash: $1,297 (532% of Medicare)
Ins. Median: $1,621 (665% 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 665% of the Medicare baseline (a markup of 565%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Molina Healthcare $153 - $1,801 63%
Meridian Health Plan $161 66%
Aetna $270 - $1,801 111%
Blue Cross Blue Shield $270 - $1,801 111%
Clear Spring Health Of Illinois $270 - $1,801 111%
Health Alliance Medical Plans $270 - $1,801 111%
Health Partners $270 - $1,801 111%
Humana $270 - $1,801 111%
Sae Hospice $270 - $1,801 111%
UnitedHealthcare $270 - $1,801 111%
Amish Community $504 207%
Celtic Insurance Company $539 - $1,801 221%
Naphcare $585 - $1,801 240%
Hopetrust $648 - $1,801 266%
Claim Doc $675 - $1,801 277%
Wellfirst $1,160 476%
First Health $1,340 550%
Cigna $1,423 - $1,801 584%
Healthlink $1,432 - $1,801 587%
Caterpillar, Inc. $1,446 593%
Consociate Group $1,585 650%
Choicecare $1,621 665%
Healthcare Finest Network (Hfn) $1,621 665%
Multiplan/Phcs $1,621 665%
Provider Network Of America $1,621 665%
City Of Springfield $1,801 739%
Current Health Solutions $1,801 739%
Healthscope $1,801 739%
Illinois Breast And Cervical Cancer Program $1,801 739%
Interplan $1,801 739%
Live360 $1,801 739%
Wexford $1,801 739%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals