CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: UPMC Horizon

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $598
Cash Discount Price: $922
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at UPMC Horizon is $598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $922. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.45x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$922

Average discount available for prompt cash payment at this facility.

Insurance Median

$598

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: $922 (378%)

Insurance Median: $598 (245%)

Cash: $922 (378% of Medicare)

Ins. Median: $598 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
UnitedHealthcare	$154 - $614	63%
Aetna	$161 - $922	66%
Upmc Health Plan	$161 - $642	66%
Geisinger	$204	84%
Highmark Wholecare (Prev Gateway)	$218 - $768	89%
Health Partners Plans (Jefferson Health Plan)	$221	91%
Amerihealth Caritas	$229 - $249	94%
Cigna	$249 - $614	102%
Pa Health & Wellness	$249 - $250	102%
Blue Cross Blue Shield	$383 - $768	157%
Upmc Work Partners	$422	173%
Intergroup	$998	409%
Coventry/First Health	$1,014	416%
Health Coalition Partners	$1,075	441%
Private Health Care Systems	$1,229	504%
Prime Net	$1,260	517%
Humana	$1,306	536%

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 $922.
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 Horizon 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.