CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Luke's Warren Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $894
  • Cash Discount Price: $11,948
  • vs. Medicare Baseline: 3.67x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Luke's Warren Hospital is $894. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,948. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.67x the Medicare baseline. Located in 185 Roseberry St, Phillipsburg, NJ.
Cash / Self-Pay
$11,948

Average discount available for prompt cash payment at this facility.

Insurance Median
$894

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: $11,948 (4901%)
Insurance Median: $894 (367%)
Cash: $11,948 (4901% of Medicare)
Ins. Median: $894 (367% 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 367% of the Medicare baseline (a markup of 267%). 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
Geisinger $173 - $3,733 71%
Amerihealth Caritas $176 72%
UPMC Health Plan $176 - $3,639 72%
Blue Cross Blue Shield $266 - $5,040 109%
UnitedHealthcare $266 - $3,585 109%
Aetna $272 - $4,633 112%
Humana $277 114%
Oscar $3,452 1416%
Cigna $3,607 1480%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 185 Roseberry St, Phillipsburg, NJ 08865
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals