CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: UPMC Hamot

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $461
Cash Discount Price: $1,022
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at UPMC Hamot is $461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,022. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.89x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$1,022

Average discount available for prompt cash payment at this facility.

Insurance Median

$461

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: $1,022 (419%)

Insurance Median: $461 (189%)

Cash: $1,022 (419% of Medicare)

Ins. Median: $461 (189% 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
Blue Cross Blue Shield	$84 - $764	34%
Upmc Health Plan	$161 - $272	66%
UnitedHealthcare	$169 - $774	69%
Aetna	$176 - $1,192	72%
Geisinger	$204	84%
Highmark Wholecare (Prev Gateway)	$218 - $852	89%
Health Partners Plans (Jefferson Health Plan)	$221	91%
Amerihealth Caritas	$229 - $287	94%
Pa Health & Wellness	$250 - $287	103%
Univera	$255 - $749	105%
Fidelis	$266	109%
Wellcare	$274	112%
Cigna	$287 - $681	118%
Independent Health	$346 - $461	142%
Upmc Work Partners	$461	189%
Intergroup	$1,107 - $1,362	454%
Multiplan	$1,192 - $1,362	489%

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 $1,022.
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 Hamot 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.