CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: UPMC Horizon

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $66
Cash Discount Price: $103
vs. Medicare Baseline: 20.82x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at UPMC Horizon is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 20.82x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $103 (3249%)

Insurance Median: $66 (2082%)

Cash: $103 (3249% of Medicare)

Ins. Median: $66 (2082% 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 2082% of the Medicare baseline (a markup of 1982%). 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 - $103	95%
Amerihealth Caritas	$3 - $5	95%
Cigna	$3 - $68	95%
Health Partners Plans (Jefferson Health Plan)	$3	95%
Highmark Wholecare (Prev Gateway)	$3 - $4	95%
Pa Health & Wellness	$3 - $5	95%
UnitedHealthcare	$3 - $68	95%
Upmc Health Plan	$3 - $14	95%
Upmc Work Partners	$3	95%
Geisinger	$4	126%
Blue Cross Blue Shield	$6 - $78	189%
Intergroup	$111	3502%
Coventry/First Health	$113	3565%
Health Coalition Partners	$120	3785%
Private Health Care Systems	$137	4322%
Prime Net	$140	4416%
Humana	$145	4574%

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 $103.
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 Horizon 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.