CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: South Miami Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $786
Cash Discount Price: $1,136
vs. Medicare Baseline: 3.22x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at South Miami Hospital is $786. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,136. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.22x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$1,136

Average discount available for prompt cash payment at this facility.

Insurance Median

$786

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: $1,136 (466%)

Insurance Median: $786 (322%)

Cash: $1,136 (466% of Medicare)

Ins. Median: $786 (322% 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 322% of the Medicare baseline (a markup of 222%). 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	$102	42%
Medicaid / KanCare	$102 - $112	42%
UnitedHealthcare	$107 - $1,748	44%
Wellcare	$107	44%
Sunshine State	$108	44%
Aetna	$110 - $1,398	45%
Vista	$110	45%
Medicare (plans)	$249 - $336	102%
Blue Cross Blue Shield	$258 - $1,133	106%
Medica Health Plan	$267	110%
Humana	$272	112%
Avmed	$274 - $865	112%
Leon Medical	$274	112%
Cigna	$284 - $1,398	117%
Non Contracted	$641 - $642	263%
Amerihealth	$786 - $787	322%
International	$1,136	466%
Dimension Health Plan	$1,310 - $1,573	537%
Affordable	$1,485 - $1,486	609%
Phcs	$1,572 - $1,573	645%
Quality Health	$1,572 - $1,573	645%

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 $1,136.
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 South Miami 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.