CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Boone County Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $11
Cash Discount Price: $20
vs. Medicare Baseline: 3.47x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Boone County Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 3.47x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $20 (631%)

Insurance Median: $11 (347%)

Cash: $20 (631% of Medicare)

Ins. Median: $11 (347% 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 347% of the Medicare baseline (a markup of 247%). 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
Va Ccn-All Plans	$1	32%
Aetna	$2 - $34	63%
Amerigroup Mcr Adv - All Other Plans	$2 - $18	63%
Choice Care Mcr Adv - All Plans	$2 - $18	63%
Humana	$2 - $40	63%
Iowa Hlth Adv - All Plans	$2 - $18	63%
Iowa Total Care Mcaid - All Plans	$2 - $20	63%
Medicaid / KanCare	$2 - $20	63%
Meridian Mcaid - All Plans	$2 - $20	63%
Mt Carmel Hp - All Plans	$2 - $18	63%
UnitedHealthcare	$2 - $26	63%
Tricare	$3	95%
Health Alliance-All Plans	$4 - $40	126%
Healthsmart Accell Network	$4 - $31	126%
Healthsmart Ppo - All Other Plans	$4 - $35	126%
Medical Associates Hp-All Plans	$4 - $33	126%
Midlands Choice-All Plans	$5 - $40	158%
Mutually Preferred-All Plans	$5 - $42	158%
Wellmark Hmo	$21	662%
Wellmark Ppo - All Other Plans	$23	726%

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 $20.
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 Boone County Hospital 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.