Urinalysis (automated, with microscopy)
Facility: Phillips County Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $32
- Cash Discount Price: $30
- vs. Medicare Baseline: 10.09x 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 1009% of the Medicare baseline (a markup of 909%). 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 | $10 - $28 | 315% |
| UnitedHealthcare | $28 - $35 | 883% |
| Medicaid / KanCare | $35 | 1104% |
| Health Partners-All Plans | $35 | 1104% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Phillips County Hospital in Phillipsburg, KS, lists a gross charge of $35.00. While the facility's cash median rate is $30.00 and the median negotiated rate across payers is $32.00, the Medicare benchmark for this service is significantly lower at $3.17. This indicates that the facility's pricing is approximately 10.1 times the Medicare rate. For patients with high-deductible plans, paying the cash price of $30.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead. Patients should verify if their specific plan has a deductible or out-of-pocket maximum that would make the insurance route more expensive than the cash option.
To ensure you are not overcharged, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities. Additionally, ask the hospital about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle that inflates the final invoice.