CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Boston Children's Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $32
Cash Discount Price: $45
vs. Medicare Baseline: 10.09x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Boston Children's Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 10.09x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $45 (1420%)

Insurance Median: $32 (1009%)

Cash: $45 (1420% of Medicare)

Ins. Median: $32 (1009% 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 1009% of the Medicare baseline (a markup of 909%). 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
Blue Cross Blue Shield	$11 - $30	347%
Unicare	$13	410%
Cdphp	$22 - $38	694%
Harvard Pilgrim	$23 - $30	726%
Aetna	$27 - $38	852%
Mgb/Allways	$27 - $33	852%
United	$27 - $38	852%
Ambetter / Centene	$28	883%
Tufts Public Plan	$28	883%
United Ri Nj Ny	$28	883%
Carelon Strategies/Bhs	$29	915%
UnitedHealthcare	$29 - $38	915%
Carelon/Beacon	$34	1073%
Fallon	$34 - $35	1073%
Health New England	$36	1136%
Cigna	$38 - $41	1199%
Ets/Lifetrac	$38	1199%
Interlink Transplant	$38	1199%
Community Health Options	$40	1262%
Humana	$40	1262%
Coventry/Hcvm/First Health	$41	1293%
Multiplan/Phcs	$41 - $43	1293%

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 $45.
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 Boston Children's 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.