Urinalysis (automated, with microscopy)
Facility: Decatur Health
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $31
- Cash Discount Price: $36
- vs. Medicare Baseline: 9.78x 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 978% of the Medicare baseline (a markup of 878%). 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 | $13 | 410% |
| Wppa/Providrs Care- All Plans | $24 | 757% |
| Humana | $25 | 789% |
| UnitedHealthcare | $25 - $31 | 789% |
| Aetna | $36 - $40 | 1136% |
| Midlands Choice- All Plans | $36 | 1136% |
| Medicaid / KanCare | $41 | 1293% |
Consumer Guidance & Cost Commentary
For the automated urinalysis with microscopy service at Decatur Health in Oberlin, Kansas, the cash median price is $36.00, which is lower than the facility's negotiated rates of $31.00 to $41.00 across various payers. While commercial insurance plans like Blue Cross Blue Shield and Medicaid/KanCare pay a fixed $13.00, other carriers such as UnitedHealthcare and Aetna negotiate rates ranging from $25.00 to $41.00. Patients with high-deductible plans may find paying the cash price of $36.00 more cost-effective than relying on insurance, as the negotiated rates for some payers exceed the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final cost.
The facility's pricing is significantly higher than the Medicare benchmark of $3.17, with the cash price representing a markup of 9.8 times the Medicare rate. This disparity highlights the importance of understanding that commercial negotiated rates often include administrative overhead and contract dynamics that drive prices well above the federal baseline. To avoid unexpected charges, patients should request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients should dispute the charge formally in writing rather than paying immediately, as the No Surprises Act protects against surprise billing for emergency and non-emergency care at in-network facilities.