CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Josephs Community Hospital West Bend

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,140
Cash Discount Price: $996
vs. Medicare Baseline: 4.68x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Josephs Community Hospital West Bend is $1,140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $996. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.68x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$996

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,140

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: $996 (409%)

Insurance Median: $1,140 (468%)

Cash: $996 (409% of Medicare)

Ins. Median: $1,140 (468% 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 468% of the Medicare baseline (a markup of 368%). 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
Allwell	$235	96%
Blue Cross Blue Shield	$235 - $1,538	96%
Community Care	$235	96%
Health Partners	$235 - $1,176	96%
Humana	$235	96%
Icare	$235	96%
Molina	$235	96%
Network Health Plan	$235 - $536	96%
Security Health Plan Secure Savers	$235	96%
UnitedHealthcare	$235 - $807	96%
Aetna	$239 - $1,267	98%
Care Wisconsin	$242	99%
Centivo	$543 - $597	223%
Froedtert South	$760	312%
Chorus Community Health Plan	$778	319%
Sheboygan Employers Health Network	$857	352%
Common Ground	$1,086	446%
Health Payment Systems	$1,140 - $1,463	468%
Wisconsin Physician Services	$1,448	594%
Trilogy	$1,484	609%
Americas Choice	$1,575	646%
Healtheos	$1,575	646%
Multiplan/Private Healthcare Systems	$1,575	646%
First Health Network	$1,593	653%
Hfn	$1,629	668%
Ibsi Passport	$1,629	668%
Cigna	$1,720	706%
Healthsmart	$1,720	706%

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 $996.
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 Josephs Community Hospital West Bend 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.