Urinalysis (automated, with microscopy)
Facility: Rooks County Health Center
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $41
- Cash Discount Price: $34
- vs. Medicare Baseline: 12.93x 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 1293% of the Medicare baseline (a markup of 1193%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $1 | 32% |
| Blue Cross Blue Shield | $10 | 315% |
| Celtic Mcr Adv | $21 | 662% |
| Tricare | $21 | 662% |
| Celtic Comm - All Other Plans | $24 | 757% |
| UnitedHealthcare | $41 | 1293% |
| Preferred Benefits Admin | $41 | 1293% |
| Aetna | $41 | 1293% |
| Preferred Hlthcare - All Other Plans | $43 | 1356% |
| Health Partners - All Plans | $43 | 1356% |
| Healthy Blue Mcaid - All Plans | $46 | 1451% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Rooks County Health Center in Plainville, KS, has a gross charge of $46.00. This rate is significantly higher than the state average, which is $3.17, and the county average, which is $12.90. While the facility's cash median is $34.00, patients with high-deductible plans might find this amount more affordable than the negotiated rates of $41.00 to $46.00 charged by various payers, as these insurance rates often include administrative overhead and do not reflect the actual cost of care. To potentially lower out-of-pocket costs, patients should ask the hospital about self-pay or prompt-pay discounts before scheduling, as paying upfront can sometimes bypass the higher insurance negotiated rates.
The facility is a Critical Access Hospital owned by a Government Hospital District, and while it holds a government ownership status, the pricing structure still reflects commercial market dynamics. It is important to note that the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, but patients should still verify their specific plan details to avoid unexpected charges. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies. Always compare the final allowed amount to the Medicare benchmark of $3.17 to ensure the facility is charging a fair price relative to the federal cost baseline.