CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Joseph's Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $2,359
  • Cash Discount Price: $1,998
  • vs. Medicare Baseline: 9.68x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Joseph's Hospital is $2,359. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,998. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 9.68x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.
Cash / Self-Pay
$1,998

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,359

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: $1,998 (820%)
Insurance Median: $2,359 (968%)
Cash: $1,998 (820% of Medicare)
Ins. Median: $2,359 (968% 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 968% of the Medicare baseline (a markup of 868%). 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 $340 - $2,775 139%
Meridian Health Plan $356 146%
Cigna $448 184%
Blue Cross Blue Shield $555 - $2,775 228%
Clear Spring Health of Illinois $555 - $2,775 228%
Humana $555 - $2,775 228%
UnitedHealthcare $555 - $2,775 228%
Aetna $555 - $2,775 228%
Sae Hospice $555 - $2,775 228%
Amish Community $777 319%
Naphcare $1,166 - $5,828 478%
Celtic Insurance Company $1,221 - $2,775 501%
Hopetrust $1,388 - $2,775 569%
Claim Doc $1,388 - $6,938 569%
Wellfirst $1,777 729%
Caterpillar, Inc. $1,995 818%
First Health $2,051 841%
Multiplan/Phcs $2,359 968%
Healthlink $2,359 968%
Healthcare Finest Network (Hfn) $2,498 1025%
Provider Network of America $2,498 1025%
Interplan $2,775 1138%
Current Health Solutions $2,775 1138%
Mental Health Network $2,775 1138%
Healthscope $2,775 1138%
Consociate Group $2,775 1138%
Health Alliance Medical Plans $2,775 1138%
Qtc Medical Group of Illinois $2,775 1138%
Illinois Breast and Cervical Cancer Program $2,775 1138%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12866 Troxler Avenue, Highland, IL 62249
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Critical Access Hospitals