CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: UPMC Somerset

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $230
Cash Discount Price: $450
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at UPMC Somerset is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $450. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.94x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$450

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $450 (185%)

Insurance Median: $230 (94%)

Cash: $450 (185% of Medicare)

Ins. Median: $230 (94% 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.

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
Geisinger	$53 - $538	22%
Aetna	$54 - $546	22%
UnitedHealthcare	$58 - $589	24%
Multiplan	$68 - $888	28%
Galaxy Health Plan	$88 - $888	36%
Humana	$101 - $1,024	41%
Blue Cross Blue Shield	$156 - $433	64%
Upmc Health Plan	$161 - $479	66%
Amerihealth Caritas	$168 - $230	69%
Highmark Wholecare (Prev Gateway)	$188 - $249	77%
Upmc Work Partners	$416	171%

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 $450.
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 Somerset 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.