Urinalysis (automated, with microscopy)
Facility: Stevens County Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $45
- Cash Discount Price: $118
- vs. Medicare Baseline: 14.20x 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 1420% of the Medicare baseline (a markup of 1320%). 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 |
|---|---|---|
| Aetna | $4 - $118 | 126% |
| Blue Cross Blue Shield | $9 - $10 | 284% |
| Humana | $44 | 1388% |
| First Health - All Plans | $106 | 3344% |
| Wppa - All Plans | $112 | 3533% |
| Medicaid / KanCare | $118 | 3722% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Stevens County Hospital in Hugoton, KS, lists a gross charge of $118.00. While the facility's cash median is $118.00, the median negotiated rate across six payers is $45.00, which is significantly lower than the cash price. This scenario highlights a common billing dynamic where commercial insurance contracts cap the cost at a rate that can be substantially lower than what a patient would pay out-of-pocket. Because commercial rates often include administrative overhead and contract premiums, patients with high-deductible plans may find that paying the cash price of $118.00 upfront is more cost-effective than relying on insurance, which could result in a higher allowed amount or a large deductible payment.
When evaluating the value of this service, it is important to compare the facility's pricing against the Medicare benchmark, which serves as the objective baseline for healthcare costs. The Medicare amount for this procedure is $3.17, and the facility's cash rate is 14.2 times higher than this federal baseline. Although the facility is a Critical Access Hospital owned by the local government, the significant markup relative to the Medicare rate reflects standard commercial pricing structures. Patients should verify their specific plan details, as some policies may offer self-pay or prompt-pay discounts that could further reduce the final cost. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients can rest assured that they will not be billed for the difference between the hospital's gross charge and their insurance allowed amount if they are covered in-network.