Urinalysis (automated, with microscopy)
Facility: Children'S Mercy South
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $23
- Cash Discount Price: $18
- 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 |
|---|---|---|
| UnitedHealthcare | $3 - $25 | 95% |
| Wppa Providrs Care | $3 - $24 | 95% |
| Healthy Blue | $4 - $9 | 126% |
| Medicaid / KanCare | $4 | 126% |
| Cigna | $5 - $26 | 158% |
| Blue Cross Blue Shield | $5 - $27 | 158% |
| Home State Health | $8 | 252% |
| Centivo | $18 - $24 | 568% |
| Medica | $21 - $22 | 662% |
| Aetna | $22 - $25 | 694% |
| Quiktrip | $24 | 757% |
| Orscheln | $24 | 757% |
| Health Midwest Comprehensive Care | $24 | 757% |
| Wellfit/Centrus | $24 | 757% |
| Nebraska Furniture Mart | $24 | 757% |
| Humana | $25 | 789% |
| Mercy Health | $26 - $28 | 820% |
| Coxhealth Network | $27 | 852% |
| Coventry Health Care Of Kansas | $27 | 852% |
| Multiplan | $28 | 883% |
| American Healthcare Alliance | $31 | 978% |
| National Preferred Provider Network | $32 - $33 | 1009% |
| Healthlink | $33 | 1041% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Children's Mercy South in Overland Park, KS, lists a cash median of $18.00, which is significantly lower than the facility's negotiated rates. While the facility's negotiated average is $23.00, commercial payers like UnitedHealthcare and Wppa Providers Care have negotiated rates ranging from $3.00 to $25.00, with Blue Cross Blue Shield showing a wide spread between $5.00 and $27.00 across its 33 plans. It is important to note that cash-pay options can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among carriers, and should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts to potentially lower the final bill.
When evaluating pricing, it is crucial to compare rates against the Medicare benchmark rather than the facility's gross charges, as the latter can be inflated to make discounts appear larger. For this procedure, the Medicare amount is $3.17, and the facility's commercial rates generally fall within the expected range of 200% to 300% of the Medicare rate, consistent with typical commercial pricing structures. The data indicates a median negotiated rate of $23.00, which serves as a reference point for commercial payers, though individual plan rates may differ. Patients should request an itemized billing audit to ensure no errors or unbundled charges are present, as over