CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Decatur Memorial Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $38
Cash Discount Price: $70
vs. Medicare Baseline: 11.99x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Decatur Memorial Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 11.99x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3.17 (100%)

Cash / Self-Pay: $70 (2208%)

Insurance Median: $38 (1199%)

Cash: $70 (2208% of Medicare)

Ins. Median: $38 (1199% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3.17 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 1199% of the Medicare baseline (a markup of 1099%). 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	$3 - $47	95%
Blue Cross Blue Shield	$3 - $70	95%
Coventry	$3 - $35	95%
Health Alliance	$3 - $47	95%
Humana	$3 - $46	95%
Medicaid / KanCare	$3	95%
Medicare (plans)	$3	95%
Tricare	$3	95%
UnitedHealthcare	$3 - $70	95%
Veterans Administration	$3	95%
Wellcare	$3	95%
Caterpillar	$4	126%
Plain Church Medical Group	$4 - $32	126%
Illinois Workers Compensation	$23 - $46	726%
Mennonite Churches	$24	757%
Health Alliance Mh Employee Plan	$32	1009%
Cigna	$33	1041%
6 Degrees Health	$42	1325%
Hopetrust	$42	1325%
Hst	$42	1325%
Commercial Workers Compensation	$44	1388%
Hfn	$44 - $52	1388%
Phcs Savility	$46	1451%
Healthlink	$48	1514%
Phcs Multiplan Ppo	$48	1514%
Corvel	$50	1577%
Consociate	$52	1640%
Liability	$70	2208%

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 $70.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 81001.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Decatur Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 81001.
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.