Urinalysis at Intermountain Health Good Samaritan Medical Center. CPT 81001.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$78.10list price
$2.06–$70.06range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | Cigna Co Public Option | $10.97 |
| Cigna | Cigna Connect Exchange | $10.97 |
| Cigna | Cigna Surefit | $10.97 |
| BCBS/Anthem | BCBS Co Federal | $18.36 |
| BCBS/Anthem | BCBS Co HMO | $18.36 |
| BCBS/Anthem | BCBS Co PPO | $18.36 |
| United Healthcare | Selectcolorado | $18.57 |
| Allegiance | Cigna Sclhs Employees | $19.52 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $19.52 |
| Cigna | Cigna HMO | $23.39 |
| Cigna | Cigna Indemnity | $23.39 |
| Cigna | Cigna Local Plus | $23.39 |
| Cigna | Cigna Other | $23.39 |
| Cigna | Cigna POS/Qpos | $23.39 |
| Cigna | Cigna PPO | $23.39 |
| Cigna | Eighth Dist Elect Ben Pln | $23.39 |
| Cigna | Health-Partners | $23.39 |
| Geha | Geha | $24.23 |
| Geha | Geha Mcr Supplemental | $24.23 |
| United Healthcare | All Savers Alternative Funding | $24.23 |
| United Healthcare | Golden Rule Ins | $24.23 |
| United Healthcare | Healthscope | $24.23 |
| United Healthcare | Medica | $24.23 |
| United Healthcare | Surest | $24.23 |
| United Healthcare | UHC Charter/Navigate | $24.23 |
| United Healthcare | UHC Exchange Plan | $24.23 |
| United Healthcare | Umr-United Med Resources | $24.23 |
| United Healthcare | United Healthcare | $24.23 |
| Aetna | Aetna Colorado Preferred | $29.05 |
| Aetna | Aetna HMO/EPO | $31.16 |
Inpatient
—cash price (self-pay)
$78.10list price
$23.04–$78.10range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $23.04 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $32.90 |
| Kaiser Perm HMO | Kaiser Out Of State | $32.90 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $32.90 |
| Kaiser Self Funded | Kaiser Self Funded | $32.90 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $33.90 |
| Private Hlthcare Sys | Phcs Other | $58.58 |
| Private Hlthcare Sys | Phcs PPO | $58.58 |
| BCBS/Anthem | BCBS Co Indemnity | $65.74 |
| Multiplan Inc | Multiplan Inc Other | $66.38 |
| Multiplan Inc | Multiplan Inc PPO | $66.38 |
| Aetna | Aetna Nap | $70.06 |
| Cigna | Cigna HMO | $78.10 |
| Cigna | Cigna Indemnity | $78.10 |
| Cigna | Cigna Local Plus | $78.10 |
| Cigna | Cigna Other | $78.10 |
| Cigna | Cigna POS/Qpos | $78.10 |
| Cigna | Cigna PPO | $78.10 |
| Cigna | Eighth Dist Elect Ben Pln | $78.10 |
| Cigna | Health-Partners | $78.10 |
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All common services at Intermountain Health Good Samaritan Medical Center