CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: St Clair Hospital

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $280
Cash Discount Price: $232
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at St Clair Hospital is $280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $232. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.15x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$232

Average discount available for prompt cash payment at this facility.

Insurance Median

$280

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: $232 (95%)

Insurance Median: $280 (115%)

Cash: $232 (95% of Medicare)

Ins. Median: $280 (115% 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
Upmc	$86 - $314	35%
UnitedHealthcare	$154 - $763	63%
Aetna	$169 - $623	69%
Amerihealth	$169 - $232	69%
Geisinger	$169 - $239	69%
Health Partners	$169 - $244	69%
Highmark	$169 - $520	69%
Pa Health And Wellness	$169 - $242	69%
Humana	$232	95%
Cigna	$242 - $280	99%
The Health Plan	$244 - $558	100%
Lantern	$500	205%

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 $232.
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 St Clair 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.