Urinalysis (automated, with microscopy)
Facility: Memorial Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $26
- Cash Discount Price: $47
- vs. Medicare Baseline: 8.20x 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 820% of the Medicare baseline (a markup of 720%). 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 | $7 | 221% |
| Medicare (plans) | $23 | 726% |
| Tricare | $23 | 726% |
| Humana | $23 | 726% |
| Ambetter / Centene | $26 | 820% |
| Coventry - All Other Plans | $42 | 1325% |
| Health Partners Of Kansas - All Plans | $44 | 1388% |
| Preferred Healthcare-All Plans | $44 | 1388% |
| Wppa/Providers Care-All Plans | $65 | 2050% |
Consumer Guidance & Cost Commentary
For the automated urinalysis with microscopy service (CPT 81001) at Memorial Hospital in Abilene, KS, the cash price is $47.00, which matches the facility's median negotiated rate. This cash price is significantly higher than the Medicare benchmark of $3.17, indicating a substantial markup relative to the federal government's fixed reimbursement rate. While the facility is a Critical Access Hospital with government ownership, patients should be aware that commercial insurance plans typically negotiate rates higher than cash prices due to administrative costs and contract structures. In this specific case, the median negotiated rate across payers is $26.00, which is lower than the cash price, suggesting that using insurance might result in a lower allowed amount, though the patient's actual out-of-pocket cost depends on their deductible and copay status.
The facility's pricing data reflects a single plan for each of the nine major payers, with negotiated rates ranging from $7.00 for Blue Cross Blue Shield to $65.00 for Wppa/Providers Care. Because the cash price of $47.00 exceeds the median negotiated rate of $26.00, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, provided they can afford the upfront cost and have not yet met their deductible. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer fee reductions for upfront payment that bypass the standard insurance billing cycle. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized statement to verify that all charges are accurate before