Urinalysis (automated, with microscopy)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $11
- Cash Discount Price: $22
- vs. Medicare Baseline: 3.47x 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 347% of the Medicare baseline (a markup of 247%). 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 |
|---|---|---|
| Aetna | $9 - $17 | 284% |
| Blue Cross Blue Shield | $10 | 315% |
| UnitedHealthcare | $11 - $13 | 347% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $22.00, which matches the facility's gross charge. This cash rate is significantly lower than the typical commercial negotiated rates observed across payers like Aetna, Blue Cross Blue Shield, and UnitedHealthcare, where allowed amounts range from $9 to $17 depending on the specific plan. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance claims, particularly for those with high-deductible plans where the negotiated rate might exceed the cash price. It is advisable to confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final amount owed.
When reviewing your bill, it is important to distinguish between the facility's gross charges and the actual amount your insurance will pay. The Medicare amount for this service is $3.17, and the facility's median negotiated rate is $11.00, which represents a markup relative to the federal benchmark. Commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price, so comparing your specific plan's allowed amount to the Medicare rate provides a clearer picture of fair pricing. If you receive a summary bill that does not itemize individual CPT codes, request a detailed line-by-line statement to identify any unbundled charges or services not rendered, as over 80% of hospital bills contain errors that can be resolved through a formal written audit dispute.