Urinalysis (automated, with microscopy)
Facility: Nmc Health
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $59
- Cash Discount Price: $64
- vs. Medicare Baseline: 18.61x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $10 | 315% |
| Aetna | $10 - $75 | 315% |
| Wppa | $50 | 1577% |
| Occunet | $55 | 1735% |
| Samaritan Ministries International | $59 | 1861% |
| Medincrease Health Plan | $59 | 1861% |
| Prime Health Services | $68 | 2145% |
| UnitedHealthcare | $82 | 2587% |
| Cigna | $86 | 2713% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, representing an automated urinalysis with microscopy at Nmc Health in Newton, Kansas, the facility's cash median price is $64.00. This cash rate is notably lower than the facility's negotiated rates, which range from $10 to $86 depending on the insurance carrier, with the median negotiated amount sitting at $59.00. While the facility's cash price is higher than the Medicare benchmark of $3.17, it remains significantly below the gross chargemaster price of $91.00. Patients with high-deductible plans may find paying the $64.00 cash rate more cost-effective than relying on insurance, as the negotiated rates for many payers exceed the cash price, potentially resulting in higher out-of-pocket costs if the patient's deductible has not yet been met.
To ensure you receive the most accurate pricing, it is essential to request a prompt-pay discount before scheduling your visit, as these upfront payment incentives can further reduce the final bill. Additionally, if you are billed by an out-of-network provider at this facility, you may be entitled to protections under the No Surprises Act, which prevents balance billing for emergency care and non-emergency services at in-network hospitals. If you receive a summary bill rather than a detailed itemized statement, you should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. Always verify your specific plan's allowed amount with the hospital prior to treatment to avoid unexpected charges.