Urinalysis (automated, with microscopy)
Facility: Graham County Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $19
- Cash Discount Price: $25
- vs. Medicare Baseline: 5.99x 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 599% of the Medicare baseline (a markup of 499%). 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 |
|---|---|---|
| Medicaid / KanCare | $5 | 158% |
| UnitedHealthcare | $5 - $24 | 158% |
| Blue Cross Blue Shield | $10 | 315% |
| Medicare (plans) | $19 | 599% |
| Celtic Commercial-All Other Plans | $21 | 662% |
| Wppa (Providers Care)-All Plans | $24 | 757% |
Consumer Guidance & Cost Commentary
For this automated urinalysis procedure at Graham County Hospital in Hill City, Kansas, the cash price is $25.00, which matches the facility's negotiated rate for Medicaid and is slightly higher than the median negotiated rate of $19.00 across other payers. While the facility's cash rate is identical to its Medicare benchmark of $3.17 plus a standard markup, it is important to note that commercial insurance plans often pay significantly more than the cash price due to administrative overhead and contract structures. For example, UnitedHealthcare and Blue Cross Blue Shield have negotiated ranges starting at $5.00 and $10.00 respectively, which may appear low but could still result in higher out-of-pocket costs for patients with high deductibles if the allowed amount exceeds the cash price. Patients should verify their specific plan's deductible status before scheduling, as paying cash upfront might be more cost-effective if the insurance negotiated rate is inflated.
To ensure you are not overcharged, it is recommended to request a full itemized bill before paying, as summary bills often obscure individual code costs and potential errors. If you receive a balance bill for the difference between the provider's chargemaster and your insurance allowed amount, you may be protected under the No Surprises Act, which bans such billing for emergency care and non-emergency services at in-network facilities. Additionally, since this facility is a Critical Access Hospital with government ownership, you should explicitly ask about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full within 30 days. Always dispute any unexpected charges in writing rather than accepting verbal assurances, and compare the facility's rates against state or county