CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Anthony Community Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $1,073
  • Cash Discount Price: $2,430
  • vs. Medicare Baseline: 4.40x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Anthony Community Hospital is $1,073. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,430. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.40x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.
Cash / Self-Pay
$2,430

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,073

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: $2,430 (997%)
Insurance Median: $1,073 (440%)
Cash: $2,430 (997% of Medicare)
Ins. Median: $1,073 (440% 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 440% of the Medicare baseline (a markup of 340%). 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
Emblem $368 - $651 151%
Cigna $605 248%
Blue Cross Blue Shield $1,073 440%
Oxford $1,556 - $2,417 638%
UnitedHealthcare $2,283 - $2,685 937%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15 Maple Avenue -19, Warwick, NY 10990
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals