CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Mercy Hospital Carthage

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $46
Cash Discount Price: $54
vs. Medicare Baseline: 14.51x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Mercy Hospital Carthage is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 14.51x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3.17 (100%)

Cash / Self-Pay: $54 (1703%)

Insurance Median: $46 (1451%)

Cash: $54 (1703% of Medicare)

Ins. Median: $46 (1451% of 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 1451% of the Medicare baseline (a markup of 1351%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$3 - $74	95%
Blue Cross Blue Shield	$3 - $23	95%
Humana	$3 - $25	95%
Medicaid / KanCare	$3 - $46	95%
Medicare (plans)	$3 - $25	95%
United Medical Resources Contracted [320454]	$4 - $75	126%
UnitedHealthcare	$4 - $72	126%
Cherokee Nation Health Serv Contracted [320066]	$23	726%
Cigna	$23 - $75	726%
Cross Timbers Hospice [20098]	$23	726%
Dept Of Veteran Affairs Contracted [320106]	$23	726%
Elara Caring Aspire Hospice [20433]	$23	726%
Globalhealth Contracted [320145]	$23	726%
Halo Hcr Inc Hospice Contracted [320432]	$23	726%
Halo Hcr Inc Hospice [20432]	$23	726%
Indian Health Service Contracted [320198]	$23	726%
Kindful Hospice Contracted [320434]	$23	726%
Kindful Hospice [20434]	$23	726%
Medical Associates Health Contracted [320444]	$23	726%
Mercy Hospice Okc [20252]	$23	726%
Mercy Mgd Behavioral Health Contracted [320259]	$23	726%
Pace Of The Ozarks Contracted [320518]	$23	726%
Provider Partners Health Plans Contracted [320450]	$23	726%
Qual Choice Contracted [320325]	$23	726%
Tricare	$23	726%
Point C Contracted [320238]	$29 - $75	915%
Health Systems Inc Contracted [320174]	$36	1136%
Insurance System Inc Contracted [320465]	$36	1136%
Administrative Payor Contracted [320005]	$37	1167%
Centivo Contracted [320505]	$38	1199%
Healthscope Contracted [320182]	$43	1356%
Ambetter / Centene	$46	1451%
Home State Health Plan Contracted [320187]	$46	1451%
Novasys Contracted [320285]	$46	1451%
Benefit Management Contracted [320052]	$50 - $72	1577%
Auxiant Contracted [320462]	$54 - $71	1703%
Healthlink Contracted [320179]	$54 - $77	1703%
Preferred Health Plan Contracted [320522]	$54	1703%
Workers Comp [20426]	$66 - $83	2082%
90 Degree Benefits Contracted [320436]	$71	2240%
Aither Health Contracted [320449]	$71	2240%
Ebms Contracted [320493]	$71	2240%
Edison Health Solutions Contracted [320502]	$71	2240%
Imagine 360 Contracted [320494]	$71	2240%
Mercy Benefit Admin Contracted [320251]	$71 - $75	2240%
Reflect Health Contracted [320492]	$71	2240%
Show-Me Health Administrators Contracted [320483]	$71	2240%
Yuzu Health Contracted [320521]	$71	2240%
Evolutions Health Care Contracted [320124]	$72	2271%
First Health Contracted [320128]	$72	2271%
Medica Contracted [320239]	$72	2271%
Multiplan Contracted [320270]	$72	2271%
Private Health Care Systems Contracted [320320]	$72	2271%
American Healthcare Alliance Contracted [320020]	$75	2366%
Ppo Plus Contracted [320310]	$75	2366%
Usa Managed Care Org Contracted [320429]	$75	2366%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $54.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 81001.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Carthage is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 81001.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.