CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: UPMC Presbyterian Shadyside

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $38
Cash Discount Price: $469
vs. Medicare Baseline: 11.99x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at UPMC Presbyterian Shadyside is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $469. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 11.99x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$469

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: $469 (14795%)

Insurance Median: $38 (1199%)

Cash: $469 (14795% 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 - $4	95%
Amerihealth Caritas	$3 - $5	95%
Cigna	$3	95%
Health Partners Plans (Jefferson Health Plan)	$3	95%
Highmark Wholecare (Prev Gateway)	$3 - $4	95%
Pa Health & Wellness	$3 - $5	95%
UnitedHealthcare	$3 - $4	95%
Upmc Health Plan	$3 - $4	95%
Upmc Work Partners	$3	95%
Multiplan	$4 - $625	126%
Geisinger	$5	158%
Blue Cross Blue Shield	$8 - $38	252%
Preferred Healthcare System	$508	16025%
Coventry/First Health	$547	17256%
Fidelis	$586	18486%
Intergroup	$586 - $664	18486%
Health Coalition Partners	$625	19716%
Private Health Care Systems	$625	19716%
Selectcare	$625	19716%
Health Payors Organization	$664	20946%
Humana	$664	20946%

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 $469.
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 UPMC Presbyterian Shadyside 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.