CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,100
Cash Discount Price: $619
vs. Medicare Baseline: 4.51x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Carilion Stonewall Jackson Hospital is $1,100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $619. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.51x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$619

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,100

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: $619 (254%)

Insurance Median: $1,100 (451%)

Cash: $619 (254% of Medicare)

Ins. Median: $1,100 (451% 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 451% of the Medicare baseline (a markup of 351%). 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
Blue Cross Blue Shield	$166 - $1,113	68%
Sentara Health Plan	$169 - $1,178	69%
Abh of VA (Formerly Coventry)	$174	71%
Abh of Wva (Formerly Coventry)	$174	71%
Humana	$174 - $227	71%
UnitedHealthcare	$174 - $1,553	71%
Aetna	$209 - $1,262	86%
Gateway - Tier 3	$899 - $1,045	369%
Vhn - Ultra	$1,014 - $1,178	416%
Connecticare	$1,144 - $1,330	469%
Gateway - Tier 2	$1,308 - $1,520	537%
Vhn - Plus	$1,308 - $1,520	537%
Cigna	$1,310 - $1,522	537%
Integrated Health Plan	$1,390 - $1,615	570%
Vhn	$1,390 - $1,615	570%
Vhn - Link	$1,472 - $1,710	604%
Beech Street	$1,504 - $1,748	617%
Gateway - Tier 1	$1,553 - $1,805	637%
Vhn - Secondary Payors	$1,553 - $1,805	637%

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 $619.
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 Carilion Stonewall Jackson 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.