CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: St Joseph's Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 81001
  • Insurance Median: $123
  • Cash Discount Price: $104
  • vs. Medicare Baseline: 38.80x Medicare
The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at St Joseph's Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 38.80x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.
Cash / Self-Pay
$104

Average discount available for prompt cash payment at this facility.

Insurance Median
$123

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: $104 (3281%)
Insurance Median: $123 (3880%)
Cash: $104 (3281% of Medicare)
Ins. Median: $123 (3880% 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 3880% of the Medicare baseline (a markup of 3780%). 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
Illinois Breast and Cervical Cancer Program $3 95%
Molina Healthcare $5 - $145 158%
Meridian Health Plan $5 158%
Caterpillar, Inc. $6 189%
UnitedHealthcare $6 - $145 189%
Cigna $8 252%
Sae Hospice $29 - $145 915%
Humana $29 - $145 915%
Aetna $29 - $145 915%
Blue Cross Blue Shield $29 - $145 915%
Clear Spring Health of Illinois $29 - $145 915%
Amish Community $41 1293%
Naphcare $61 - $304 1924%
Celtic Insurance Company $64 - $145 2019%
Hopetrust $72 - $145 2271%
Claim Doc $72 - $362 2271%
Wellfirst $93 2934%
First Health $107 3375%
Healthlink $123 3880%
Multiplan/Phcs $123 3880%
Healthcare Finest Network (Hfn) $130 4101%
Provider Network of America $130 4101%
Current Health Solutions $145 4574%
Consociate Group $145 4574%
Mental Health Network $145 4574%
Qtc Medical Group of Illinois $145 4574%
Interplan $145 4574%
Health Alliance Medical Plans $145 4574%
Healthscope $145 4574%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12866 Troxler Avenue, Highland, IL 62249
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Critical Access Hospitals