CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Children's Hospital of Philadelphia

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $101
Cash Discount Price: $232
vs. Medicare Baseline: 31.86x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Children's Hospital of Philadelphia is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $232. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 31.86x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$232

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $232 (7319%)

Insurance Median: $101 (3186%)

Cash: $232 (7319% of Medicare)

Ins. Median: $101 (3186% 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 3186% of the Medicare baseline (a markup of 3086%). 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
Geisinger Medical Assistance	$4	126%
Highmark Wholecare	$4	126%
Horizon Nj Health	$8	252%
Medicaid / KanCare	$35 - $41	1104%
UnitedHealthcare	$36 - $138	1136%
Health Partners	$40 - $47	1262%
Aetna	$51 - $125	1609%
Upmc Medical Assistance	$58 - $68	1830%
Keystone First Chip	$66 - $78	2082%
Keystone Health Plan East	$68 - $79	2145%
Blue Cross Blue Shield	$76 - $100	2397%
Geisinger Health Plan Commercial	$94 - $110	2965%
Jefferson Health Plans	$101 - $119	3186%
Cigna	$107 - $125	3375%
Highmark	$107 - $125	3375%
Qualcare	$118 - $138	3722%
First Health Network	$139 - $163	4385%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$171 - $201	5394%
Private Health Care Systems	$171 - $201	5394%
Choice Care Network	$193 - $226	6088%

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 $232.
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 Children's Hospital of Philadelphia 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.