Urinalysis (automated, with microscopy)
Facility: Lane County Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $36
- Cash Discount Price: $32
- vs. Medicare Baseline: 11.36x 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 1136% of the Medicare baseline (a markup of 1036%). 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 |
|---|---|---|
| Aetna | $22 - $38 | 694% |
| UnitedHealthcare | $22 - $40 | 694% |
| Healthy Blue Mcr Adv - All Other Plans | $24 - $40 | 757% |
| Healthy Blue Mcaid | $24 - $40 | 757% |
| Medicaid / KanCare | $24 - $44 | 757% |
| Wppa Providers-All Plans | $36 - $60 | 1136% |
Consumer Guidance & Cost Commentary
For this urinalysis procedure at Lane County Hospital in Dighton, the cash price is $32.00, which matches the facility's median negotiated rate of $36.00 and the state average of $32.00. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $22 to $44, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. Because commercial rates can be inflated by administrative processing costs, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass the higher negotiated fees.
The Medicare benchmark for this service is $3.17, which serves as a critical baseline for evaluating pricing fairness. The facility's cash rate of $32.00 represents a significant markup compared to the federal government's cost-based reimbursement, a common practice in commercial healthcare where negotiated rates average 200% to 300% of Medicare levels. If you receive a bill that includes charges for services not rendered or unbundled components, you should request a formal itemized audit to identify errors, as over 80% of hospital bills contain mistakes. Remember that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, you should still verify your specific plan details and dispute any unexpected charges in writing rather than accepting summary bills as final.