CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St James Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $128
Cash Discount Price: $460
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St James Hospital is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $460. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.53x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$460

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $460 (189%)

Insurance Median: $128 (53%)

Cash: $460 (189% of Medicare)

Ins. Median: $128 (53% 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.

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
Blue Cross Blue Shield	$21 - $713	9%
Medicaid / KanCare	$23 - $389	9%
Fidelis 5155	$24 - $151	10%
Aetna	$27 - $319	11%
Excellus 2201	$27 - $178	11%
Medicare (plans)	$27 - $351	11%
UnitedHealthcare	$28 - $319	11%
Mvp 2900	$30 - $693	12%
Cigna	$41 - $717	17%
Capital District Physicians Health Plan (Cdphp) 5149	$81 - $460	33%
Molina Healthcare 1723	$109 - $245	45%
Humana	$319	131%
Empire Plan 5179	$673	276%

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 $460.
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 St James 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.