Urinalysis (automated, with microscopy)
Facility: Holton Community Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $28
- Cash Discount Price: $26
- vs. Medicare Baseline: 8.83x 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 883% of the Medicare baseline (a markup of 783%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $10 | 315% |
| UnitedHealthcare | $18 - $34 | 568% |
| Humana | $18 | 568% |
| Aetna | $18 - $34 | 568% |
| Kansas Superior Select - All Plans | $19 | 599% |
| Preferred Health Fn Select - All Other Plans | $28 | 883% |
| Preferred Health Freedom | $28 | 883% |
| Preferred Health Professionals | $28 | 883% |
| Wppa Providers - All Plans | $33 | 1041% |
| Medicaid / KanCare | $34 | 1073% |
Consumer Guidance & Cost Commentary
For the automated urinalysis procedure at Holton Community Hospital, the cash price of $26.00 is notably lower than the negotiated rates charged to most major insurance payers, which range from $18.00 to $34.00. While the facility's cash rate is higher than the state average of $18.00, it remains below the gross chargemaster price of $34.00. Patients with high-deductible plans or those without insurance may find this cash price advantageous, as paying upfront avoids the administrative overhead and potential markups associated with insurance billing cycles. However, because the cash rate exceeds the median negotiated amount of $28.00 for some payers, individuals with active coverage should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than their insurer would cover.
The facility's pricing structure reflects a typical Critical Access Hospital model in Kansas, where the Medicare benchmark of $3.17 serves as the baseline for evaluating commercial rates. Commercial negotiated rates here average significantly higher than the Medicare rate, illustrating the standard markup in the healthcare system. To minimize costs, patients should proactively request a "self-pay" or "prompt-pay" discount from the billing department, as these upfront payment incentives can reduce the final balance. Furthermore, if a patient receives a bill from an out-of-network provider or encounters unexpected charges, they should request a full itemized audit to identify any errors or unbundled codes before agreeing to pay the full amount, ensuring they are not subject to balance billing where prohibited by federal law.