CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Nicholas Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $1,024
  • Cash Discount Price: $1,059
  • vs. Medicare Baseline: 4.20x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Nicholas Hospital is $1,024. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,059. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.20x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$1,059

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,024

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: $1,059 (434%)
Insurance Median: $1,024 (420%)
Cash: $1,059 (434% of Medicare)
Ins. Median: $1,024 (420% 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 420% of the Medicare baseline (a markup of 320%). 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
Blue Cross Blue Shield $72 - $1,604 30%
Community Care Family Care $72 30%
Managed Health Services $72 30%
Medicaid / KanCare $72 30%
Meridian Health Plan $72 30%
Molina Healthcare $76 - $1,604 31%
Triology $76 - $1,267 31%
Aetna $234 - $1,604 96%
Humana $234 - $1,604 96%
Medica $234 - $1,604 96%
Medicare (plans) $234 - $1,604 96%
UnitedHealthcare $234 - $1,604 96%
Security Health Plan $236 - $1,620 97%
P360 Small Group $437 179%
Prevea Health Network $437 179%
Naphcare $526 216%
Molina Healthcare Of Wi $802 329%
Hshs Employees $869 356%
Arise Health Plan $962 395%
Wea Provider Network $994 - $1,155 408%
Cigna $1,123 461%
Interplan $1,123 461%
Network Health Plan $1,123 461%
Health Care Alliance $1,171 480%
Health Eos $1,203 493%
Healthsmart $1,203 493%
Wisconsin Physician Service $1,283 526%
Multiplan/Phcs $1,347 553%
Choicecare $1,363 559%
North Central Healthcare Alliance $1,476 605%
First Health $1,524 625%
Caterpillar, Inc. $1,604 658%
Cofinity $1,604 658%
Live360 $1,604 658%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals