Urinalysis (automated, with microscopy)
Facility: Ellsworth County Medical Center
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $11
- Cash Discount Price: $12
- vs. Medicare Baseline: 3.47x 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 347% of the Medicare baseline (a markup of 247%). 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 |
|---|---|---|
| Triwest -All Plans | $6 | 189% |
| Healthy Blue Mcr Adv | $6 | 189% |
| Va Ccn-All Plans | $6 | 189% |
| Humana | $6 - $11 | 189% |
| UnitedHealthcare | $8 - $12 | 252% |
| Blue Cross Blue Shield | $9 - $10 | 284% |
| Aetna | $11 | 347% |
| First Health - All Plans | $11 | 347% |
| Cigna | $11 | 347% |
| Healthy Blue Mcaid- All Other Plans | $12 | 379% |
| Medicaid / KanCare | $12 | 379% |
| Coventry Mcaid-All Plans | $12 | 379% |
| Providers Care-Wppa-All Plans | $18 | 568% |
Consumer Guidance & Cost Commentary
For the automated urinalysis with microscopy (CPT 81001) at Ellsworth County Medical Center in Ellsworth, KS, the cash price is $12.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average of $6.00, meaning patients paying out-of-pocket are paying double the typical cost for this service in Kansas. While the facility's negotiated rates with major payers like Humana and UnitedHealthcare range from $8.00 to $12.00, these amounts often exceed the cash price, suggesting that for patients with high-deductible plans or those without insurance, paying the $12.00 cash rate directly may be the most cost-effective option. It is important to note that commercial insurance contracts often include administrative overheads that inflate negotiated rates above the actual cash price, so verifying the specific allowed amount with your insurer before scheduling is essential to avoid unexpected costs.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network emergency care at in-network facilities, it does not automatically eliminate all surprise charges for non-emergency ancillary services like laboratory tests. If a patient chooses to pay cash, they should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the $12.00 charge by 20% to 50% if paid upfront, bypassing the costly insurance claims processing cycle. Additionally, since over 80% of hospital bills contain errors, patients should request a full itemized statement rather than accepting a summary bill, ensuring they can identify any unbundled codes or services not rendered.