Urinalysis (automated, with microscopy)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $23
- Cash Discount Price: $20
- vs. Medicare Baseline: 7.26x 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 726% of the Medicare baseline (a markup of 626%). 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 | $9 - $10 | 284% |
| UnitedHealthcare | $22 - $25 | 694% |
| Providers Care (Wppa)-All Plans | $44 | 1388% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), the facility's cash median rate of $20.00 is lower than the negotiated rates of $23.00 paid by UnitedHealthcare and Providers Care (Wppa)-All Plans. While the gross charge is $25.00, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds this amount. It is important to note that the cash rate is also higher than the Medicare benchmark of $3.17, which serves as the federal cost baseline for this service. To maximize savings, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront, bypassing the administrative costs associated with insurance claims processing.
The facility, a Critical Access Hospital in Anthony, KS, has three payers with negotiated rates ranging from $9 to $44, with a median negotiated payment of $23.00. This negotiated amount is slightly higher than the facility's cash median but remains significantly below the gross charge, illustrating the impact of contractual ceilings on pricing. When evaluating costs, it is crucial to compare these rates against the Medicare benchmark rather than the inflated gross charge, as commercial rates often average 200% to 300% of the Medicare rate. Additionally, patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, protecting consumers from unexpected out-of-pocket differences between the provider's charge and the insurance allowed amount.