CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $1,119
Cash Discount Price: $1,209
vs. Medicare Baseline: 4.59x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Gundersen St Josephs Hospital and Clinics is $1,119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,209. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.59x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$1,209

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,119

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: $1,209 (496%)

Insurance Median: $1,119 (459%)

Cash: $1,209 (496% of Medicare)

Ins. Median: $1,119 (459% 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 459% of the Medicare baseline (a markup of 359%). 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
Amerigroup	$71	29%
Security Health Plan	$408	167%
Blue Cross Blue Shield	$438 - $1,515	180%
Iowa Total Care	$438	180%
Managed Health Service	$438	180%
Alliance	$935 - $1,236	384%
Ucare	$1,082 - $1,665	444%
UnitedHealthcare	$1,103 - $1,455	452%
Quartz	$1,134	465%
Cigna	$1,706	700%
Aspirus Arise Health	$1,727	708%
Humana	$1,769	726%
Multiplan/Healtheos	$1,810 - $1,977	743%
Coventry Health Care	$1,977	811%

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 $1,209.
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 Gundersen St Josephs Hospital and Clinics 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.