Urinalysis (automated, with microscopy)
Facility: Lmh
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $3
- Cash Discount Price: $53
- vs. Medicare Baseline: 0.95x 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.
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 |
|---|---|---|
| Aetna | $3 - $175 | 95% |
| Haskell Indian Health Services | $3 | 95% |
| Humana | $3 | 95% |
| Medicare (plans) | $3 | 95% |
| Cigna | $3 - $140 | 95% |
| Allwell | $3 | 95% |
| Blue Cross Blue Shield | $3 - $136 | 95% |
| UnitedHealthcare | $3 - $46 | 95% |
| Ambetter / Centene | $5 | 158% |
| Non Contracted | $168 | 5300% |
| First Health | $196 | 6183% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), the facility in Lawrence, KS, lists a gross charge of $210.00. While the facility's cash median price is $53.00, commercial insurance negotiated rates vary significantly, ranging from $3.00 to $196.00 depending on the payer. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, patients with high-deductible plans may find paying the cash price of $53.00 more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility's pricing is evaluated against federal benchmarks, showing a ratio of 0.9 compared to Medicare rates, indicating the commercial rates are slightly lower than the Medicare benchmark for this service. However, the data does not provide specific state or county average figures for comparison. Given that over 80% of hospital bills often contain errors, consumers are advised to request a detailed, itemized bill before paying to ensure accuracy and avoid double-billing or unbundled charges. If a balance bill arises from an out-of-network provider, patients should be aware of federal protections under the No Surprises Act that may prevent them from being billed for the difference between the provider's rate and the insurance allowed amount.