Urinalysis (automated, with microscopy)
Facility: Wamego Health Center
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $3
- Cash Discount Price: $36
- vs. Medicare Baseline: 0.95x 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.
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 |
|---|---|---|
| Providrs Care | $3 | 95% |
| UnitedHealthcare | $3 | 95% |
| Medicaid / KanCare | $3 | 95% |
| Aetna | $3 | 95% |
| Blue Cross Blue Shield | $76 - $81 | 2397% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), at Wamego Health Center in Wamego, KS, the facility's cash median price is $36.00, which is significantly lower than the gross charge of $90.00. While the facility is in-network for five payers including Medicaid/KanCare, UnitedHealthcare, and Aetna, the negotiated rates paid by these insurers average $3.00, which is notably lower than the cash price. This scenario highlights a common billing dynamic where cash-pay options can be more cost-effective for patients with high-deductible plans or those without insurance, as the insurance negotiated rate in this instance exceeds the cash price. Patients should verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the facility's gross chargemaster. The Medicare amount for this procedure is $3.17, and the facility's cash rate of $36.00 represents a markup relative to this federal baseline. Although the data does not provide specific state or county average comparisons for this code, the principle of Medicare benchmarking remains the most reliable method for understanding the true cost of care versus commercial pricing. To ensure you are not overcharged, patients should request an itemized billing audit if they receive a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you have out-of-network ancillary