CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 93970
Insurance Median: $785
Cash Discount Price: $1,003
vs. Medicare Baseline: 3.22x Medicare

The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at UPMC Children's Hospital of Pittsburgh is $785. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,003. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.22x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$1,003

Average discount available for prompt cash payment at this facility.

Insurance Median

$785

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: $1,003 (411%)

Insurance Median: $785 (322%)

Cash: $1,003 (411% of Medicare)

Ins. Median: $785 (322% 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 322% of the Medicare baseline (a markup of 222%). 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
Aetna	$198 - $919	81%
Health Plan Of Upper Ohio Valley	$230 - $1,086	94%
Blue Cross Blue Shield	$245 - $836	101%
Amerihealth Caritas	$249 - $549	102%
Cigna	$249 - $919	102%
Upmc Health Plan	$339 - $595	139%
UnitedHealthcare	$453 - $785	186%
Health Partners Plans (Jefferson Health Plan)	$568	233%
Highmark Wholecare (Prev Gateway)	$592	243%
Pa Health & Wellness	$594	244%
Geisinger	$603 - $751	247%
Intergroup	$1,086 - $1,420	446%
Coventry/First Health	$1,337	548%
Saudi Armed Forces	$1,337	548%
Health Payors Organization	$1,420	583%
Multiplan	$1,420	583%
National Provider Network	$1,504	617%
Private Health Care Systems	$1,504	617%

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 $1,003.
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 Children's Hospital of Pittsburgh 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.