CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: UPMC Mercy

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $708
Cash Discount Price: $1,214
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at UPMC Mercy is $708. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,214. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.90x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$1,214

Average discount available for prompt cash payment at this facility.

Insurance Median

$708

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: $1,214 (498%)

Insurance Median: $708 (290%)

Cash: $1,214 (498% of Medicare)

Ins. Median: $708 (290% 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 290% of the Medicare baseline (a markup of 190%). 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
Blue Cross Blue Shield	$158 - $896	65%
Upmc Health Plan	$161 - $479	66%
UnitedHealthcare	$169	69%
Highmark Wholecare (Prev Gateway)	$218 - $249	89%
Amerihealth Caritas	$232 - $249	95%
Aetna	$242 - $810	99%
Pa Health & Wellness	$249 - $250	102%
Upmc Work Partners	$470	193%
Cigna	$688 - $1,214	282%
Bravo	$708	290%
Coventry/First Health	$891	366%
Intergroup	$1,012 - $1,619	415%
Private Health Care Systems	$1,518	623%
American Healthcare Group	$1,619	664%
National Provider Network	$1,660	681%
Health Payors Organization	$1,822	747%
Multiplan	$1,822	747%

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 $1,214.
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 UPMC Mercy 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.