Urinalysis (automated, with microscopy)
Facility: Clara Barton Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $39
- Cash Discount Price: $30
- vs. Medicare Baseline: 12.30x 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 1230% of the Medicare baseline (a markup of 1130%). 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 | $10 | 315% |
| 6 Degrees Health - All Plans | $30 | 946% |
| Wppa-All Plans | $34 | 1073% |
| UnitedHealthcare | $39 | 1230% |
| Phcs - All Plans | $39 | 1230% |
| Aetna | $39 | 1230% |
| Hlth Partners Of Ks-All Plans | $40 | 1262% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Clara Barton Hospital in Hoisington, KS, has a gross charge of $43.00. While the facility's cash median rate is $30.00, which is lower than the negotiated rates of $39.00 paid by major payers like Blue Cross Blue Shield and UnitedHealthcare, patients should be aware that commercial insurance often results in higher out-of-pocket costs due to administrative fees and contract structures. The facility's negotiated rate of $39.00 is 12.3% higher than the Medicare benchmark of $3.17, indicating a significant markup relative to the federal cost baseline. Given that the cash price is lower than the insurance allowed amount, individuals with high-deductible plans may find it financially advantageous to pay the cash rate directly, provided they verify the facility's self-pay or prompt-pay discounts before scheduling.
Patients should exercise caution regarding balance billing and billing errors, as summary bills often obscure individual line items that could lead to unexpected charges. If a bill is received, it is recommended to request a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Furthermore, while the No Surprises Act protects against balance billing for emergency care at in-network facilities, patients should still review their specific plan details to ensure ancillary services are covered appropriately. By comparing the facility's rates against the Medicare benchmark and understanding the difference between gross charges and negotiated amounts, consumers can make informed decisions about their healthcare spending.