CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Tomah Memorial Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $590
Cash Discount Price: $718
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Tomah Memorial Hospital is $590. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $718. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.42x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$718

Average discount available for prompt cash payment at this facility.

Insurance Median

$590

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: $718 (295%)

Insurance Median: $590 (242%)

Cash: $718 (295% of Medicare)

Ins. Median: $590 (242% 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 242% of the Medicare baseline (a markup of 142%). 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
UnitedHealthcare	$26 - $1,701	11%
Blue Cross Blue Shield	$30 - $1,660	12%
Group Hlth Mcr Adv - All Plans	$30 - $613	12%
Independent Care Mcr - All Other Plans	$30 - $613	12%
Quartz Mcr Adv	$30 - $613	12%
Security Hp Mcr Adv	$30 - $613	12%
Va Ccn - All Plans	$30 - $613	12%
Aetna	$35 - $1,534	14%
The Alliance - All Plans	$77 - $2,706	32%
Independent Care Mcaid	$152 - $265	62%
Managed Hlth Mcaid - All Plans	$152 - $265	62%
Quartz Mcaid	$152 - $265	62%
Security Hp Mcaid	$152 - $265	62%
Security Hp Comm - All Other Plans	$590 - $1,534	242%
Humana	$613 - $1,669	251%
Quartz Comm - All Other Plans	$625 - $1,624	256%
Cigna	$674 - $1,750	276%

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 $718.
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 Tomah Memorial 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.