CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Anthony Community Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $1,277
  • Cash Discount Price: $4,416
  • vs. Medicare Baseline: 5.24x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Anthony Community Hospital is $1,277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,416. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.24x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.
Cash / Self-Pay
$4,416

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,277

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: $4,416 (1812%)
Insurance Median: $1,277 (524%)
Cash: $4,416 (1812% of Medicare)
Ins. Median: $1,277 (524% 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 524% of the Medicare baseline (a markup of 424%). 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
Medicare (plans) $296 - $317 121%
Hamaspik (McR) $296 121%
Mvp Gold (McR) $296 121%
Tricare $298 - $6,112 122%
Affinity By Molina McR $311 128%
Emblem $368 - $651 151%
Emblem Select Care (Exchange) $418 - $504 171%
Emblem Ghi/Hip PPO $491 - $592 201%
Cigna $605 - $3,091 248%
Aetna $620 - $2,208 254%
Mvp Exchange $640 263%
Geisinger Health Commercial/Exchange $978 401%
Blue Cross Blue Shield $1,063 - $3,003 436%
Self-Pay $1,177 483%
Mvp Hmo/Ppo $1,244 510%
Self-Pay - Cc 30% $1,325 544%
Oxford $1,556 - $2,417 638%
Oxford Commercial $1,668 684%
Self-Pay - Cc 50% $2,208 906%
Cdphp $2,208 906%
UnitedHealthcare $2,283 - $2,879 937%
Oxford Exchange $2,447 1004%
PHCS $3,312 1359%
Multiplan $3,312 1359%
Emblem Ghi/Hip Hmo/Epo/Pos $3,533 1449%
Magnacare Preferred $3,974 1630%
First Health $4,416 1812%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15 Maple Avenue -19, Warwick, NY 10990
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals