Urinalysis (automated, with microscopy)
Facility: Hamilton County Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $10
- Cash Discount Price: $12
- vs. Medicare Baseline: 3.15x 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 315% of the Medicare baseline (a markup of 215%). 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 | $5 - $10 | 158% |
| First Health Coventry - All Plans | $10 | 315% |
| UnitedHealthcare | $11 | 347% |
| Cigna | $11 | 347% |
| Va Ccn - All Plans | $12 | 379% |
| Aetna | $20 | 631% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Hamilton County Hospital in Syracuse, KS, lists a cash median price of $12.00, which matches the gross charge. This cash rate is significantly higher than the Medicare benchmark of $3.17, reflecting a markup common in commercial pricing where negotiated rates often range between 200% and 300% of the federal baseline. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rates for in-network payers like Blue Cross Blue Shield and Aetna can exceed the cash amount. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing.
The median amount paid by insurance carriers for this service is $11.00, with negotiated rates averaging $10.00 across six different payers, including First Health Coventry and UnitedHealthcare. These commercial rates remain well above the Medicare benchmark, illustrating that being in-network does not guarantee the lowest possible price, as insurers often set contractual ceilings that are higher than cash prices due to administrative overhead and contract dynamics. Patients should verify their deductible status before scheduling, as using insurance may result in out-of-pocket costs that exceed the cash rate if the deductible has not been met. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients can confidently