CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Valley West Community Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $56
Cash Discount Price: $62
vs. Medicare Baseline: 17.67x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Valley West Community Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 17.67x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $62 (1956%)

Insurance Median: $56 (1767%)

Cash: $62 (1956% of Medicare)

Ins. Median: $56 (1767% 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 1767% of the Medicare baseline (a markup of 1667%). 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	$16 - $75	505%
Global Excel [1712]	$16 - $17	505%
Humana	$16 - $17	505%
Aetna	$21 - $64	662%
Health'S Finest Network [126]	$38 - $78	1199%
The Alliance [1703]	$46 - $50	1451%
Choicecare [177]	$57 - $62	1798%
Healthlink [125]	$63 - $69	1987%
Multiplan/Phcs [142]	$67 - $92	2114%
First Health Plan [6034]	$84 - $92	2650%
UnitedHealthcare	$84 - $92	2650%

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 $62.
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 Valley West Community 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.