CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 81001
  • Insurance Median: $92
  • Cash Discount Price: $74
  • vs. Medicare Baseline: 29.02x Medicare
The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at HSHS St Elizabeth's Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 29.02x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$74

Average discount available for prompt cash payment at this facility.

Insurance Median
$92

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: $74 (2334%)
Insurance Median: $92 (2902%)
Cash: $74 (2334% of Medicare)
Ins. Median: $92 (2902% 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 2902% of the Medicare baseline (a markup of 2802%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Meridian Health Plan $2 63%
Molina Healthcare $2 - $103 63%
Aetna $3 - $103 95%
Blue Cross Blue Shield $3 - $103 95%
Clear Spring Health Of Illinois $3 - $103 95%
Health Alliance Medical Plans $3 - $103 95%
Health Partners $3 - $103 95%
Humana $3 - $103 95%
Illinois Breast And Cervical Cancer Program $3 95%
Sae Hospice $3 - $103 95%
UnitedHealthcare $3 - $103 95%
Celtic Insurance Company $7 - $103 221%
Naphcare $7 - $103 221%
Claim Doc $8 - $103 252%
Hopetrust $8 - $103 252%
Amish Community $29 915%
Wellfirst $66 2082%
First Health $77 2429%
Cigna $81 - $103 2555%
Healthlink $82 - $103 2587%
Caterpillar, Inc. $83 2618%
Consociate Group $91 2871%
Choicecare $93 2934%
Healthcare Finest Network (Hfn) $93 2934%
Multiplan/Phcs $93 2934%
Provider Network Of America $93 2934%
City Of Springfield $103 3249%
Current Health Solutions $103 3249%
Healthscope $103 3249%
Interplan $103 3249%
Live360 $103 3249%
Wexford $103 3249%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals