CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Hospital for Special Surgery

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $954
Cash Discount Price: $741
vs. Medicare Baseline: 3.91x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Hospital for Special Surgery is $954. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $741. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.91x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$741

Average discount available for prompt cash payment at this facility.

Insurance Median

$954

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: $741 (304%)

Insurance Median: $954 (391%)

Cash: $741 (304% of Medicare)

Ins. Median: $954 (391% 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 391% of the Medicare baseline (a markup of 291%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Fidelis	$27 - $32	11%
Metro Plus	$32 - $33	13%
Emblem	$36 - $373	15%
UnitedHealthcare	$36 - $974	15%
Blue Cross Blue Shield	$109 - $1,072	45%
Fidelis Essential [1323]	$245	101%
Cigna	$440 - $1,060	180%
Horizon	$478	196%
Aetna	$526 - $974	216%
Nyship	$558	229%
Oxford [1096]	$753 - $974	309%
Geha [1053]	$829	340%
Student Resources [1103]	$829 - $974	340%
Apwu [1016]	$954 - $1,060	391%
Nalc [1090]	$954 - $1,060	391%
Qualcare [1101]	$954 - $1,060	391%
Wellfleet [1361]	$954 - $1,060	391%
Affinity By Molina Health Plan [1005]	$974 - $1,183	400%
Christian Brothers [1034]	$974	400%
Connecticare [1039]	$974 - $1,072	400%
Emblem Health [1043]	$974 - $1,072	400%
Harvard Pilgrim [1057]	$974	400%
Medicare (plans)	$974	400%
Meritain Health [1085]	$974	400%
Nippon Life [1092]	$974	400%
Webtpa [1356]	$974	400%

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 $741.
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 Hospital for Special Surgery 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.