Urinalysis (automated, with microscopy)
Facility: Wilson Medical Center
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $14
- Cash Discount Price: $14
- vs. Medicare Baseline: 4.42x 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 442% of the Medicare baseline (a markup of 342%). 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 |
|---|---|---|
| Tricare | $10 | 315% |
| Ambetter / Centene | $10 - $18 | 315% |
| Blue Cross Blue Shield | $10 - $18 | 315% |
| UnitedHealthcare | $10 - $17 | 315% |
| Aetna | $10 - $18 | 315% |
| Humana | $10 | 315% |
| Cigna | $14 | 442% |
| Mulitplan-All Plans | $17 | 536% |
| Health Partners-All Plans | $17 | 536% |
Consumer Guidance & Cost Commentary
For patients at Wilson Medical Center in Neodesha, KS, the automated urinalysis with microscopy carries a cash price of $14.00, which is notably lower than the facility's negotiated rates of $14.00 and the Medicare benchmark of $3.17. While commercial payers like Tricare and Humana have negotiated rates as low as $10.00, other insurers such as Aetna and Blue Cross Blue Shield have rates ranging up to $18.00, meaning the cash price could be the most economical option for those with high-deductible plans or those without insurance. It is important to note that while the facility is a Critical Access Hospital owned by the local government, patients should verify their specific plan's allowed amount before scheduling, as some in-network rates exceed the cash price. Additionally, patients should inquire about self-pay or prompt-pay discounts, which can further reduce the final cost if paid in full upfront.
When reviewing the bill, consumers should be aware that summary invoices may obscure individual charges, so requesting a detailed itemized statement is essential to identify any errors or unbundled codes. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to ensure that ancillary services like laboratory tests are properly classified to avoid unexpected charges. Given that over 80% of hospital bills contain errors, patients should dispute any discrepancies in writing rather than accepting verbal assurances, and they should compare the facility's rates against state averages to ensure fair pricing. Ultimately, understanding the difference between the gross chargemaster, the Medicare benchmark, and the negotiated rate allows patients to make informed decisions about their healthcare spending.