Urinalysis (automated, with microscopy)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $17
- Cash Discount Price: $18
- vs. Medicare Baseline: 5.36x 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 536% of the Medicare baseline (a markup of 436%). 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 |
|---|---|---|
| Tricare | $14 | 442% |
| Humana | $16 | 505% |
| Hpk-All Plans | $17 | 536% |
| Aetna | $17 - $18 | 536% |
| UnitedHealthcare | $17 | 536% |
| Medicaid / KanCare | $18 | 568% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Medicine Lodge Memorial Hospital in Medicine Lodge, KS, lists a cash median price of $18.00 and a median negotiated rate of $17.00. This facility, a Critical Access Hospital owned by a Government Hospital District, has a negotiated rate that is 5.4% lower than the Medicare benchmark of $3.17. While the gross charge is $18.00, patients with high-deductible plans may find that paying the cash price directly is more cost-effective than using insurance, as the negotiated rate of $17.00 is often higher than the cash price due to administrative overhead and contract dynamics. It is important to note that while the facility offers a median negotiated rate of $17.00 across six payers including Tricare, Humana, and Aetna, this amount represents the maximum allowed by insurers rather than the lowest possible price available.
Patients should be aware that commercial insurance rates often include significant administrative costs, which can inflate the baseline price by 20% to 40% compared to direct cash payments. To minimize costs, individuals should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount for upfront payment. Since over 80% of hospital bills contain errors, consumers are advised to request a full itemized CPT-coded bill before agreeing to pay, ensuring no services were double-billed or unbundled. Additionally, if a patient receives care from an out-of-network provider at this in-network facility, the