Urinalysis (automated, with microscopy)
Facility: Susan B Allen Memorial Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $554
- Cash Discount Price: $16
- vs. Medicare Baseline: 174.76x 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 17476% of the Medicare baseline (a markup of 17376%). 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 | $350 | 11041% |
| Providrs Care | $757 | 23880% |
Consumer Guidance & Cost Commentary
For the automated urinalysis procedure at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $16.00, which is significantly lower than the negotiated rates of $554.00 paid by UnitedHealthcare and Providrs Care. While commercial insurance contracts often result in higher out-of-pocket costs for patients with high deductibles, the facility's cash rate offers a clear alternative for those paying directly. It is important to note that cash payments can sometimes be cheaper than insurance reimbursement if the negotiated rate exceeds the cash price, so patients should always ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the lowest possible rate.
This service is priced at $25.00 gross, with a Medicare benchmark of $3.17, indicating a substantial markup compared to federal reimbursement standards. Although specific county or state average data was not provided in this report, the disparity between the Medicare rate and the cash price highlights the importance of understanding how commercial rates are structured. To avoid unexpected costs, patients should request an itemized bill to verify that no unbundled codes or services not rendered are included, and they should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, verifying the network status of specific ancillary services remains a critical step in managing medical expenses.