CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $59
Cash Discount Price: $76
vs. Medicare Baseline: 18.61x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at UPMC Children's Hospital of Pittsburgh is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 18.61x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $76 (2397%)

Insurance Median: $59 (1861%)

Cash: $76 (2397% of Medicare)

Ins. Median: $59 (1861% 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 1861% of the Medicare baseline (a markup of 1761%). 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 - $69	95%
Amerihealth Caritas	$3 - $11	95%
Blue Cross Blue Shield	$3 - $36	95%
Cigna	$3 - $69	95%
Health Plan Of Upper Ohio Valley	$3 - $82	95%
Upmc Health Plan	$7 - $17	221%
Geisinger	$12 - $57	379%
Health Partners Plans (Jefferson Health Plan)	$12	379%
Highmark Wholecare (Prev Gateway)	$12	379%
Pa Health & Wellness	$12	379%
UnitedHealthcare	$12 - $59	379%
Intergroup	$82 - $107	2587%
Coventry/First Health	$101	3186%
Saudi Armed Forces	$101	3186%
Health Payors Organization	$107	3375%
Multiplan	$107	3375%
National Provider Network	$113	3565%
Private Health Care Systems	$113	3565%

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 $76.
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 Children's Hospital of Pittsburgh 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.