Urinalysis (automated, with microscopy)
Facility: Hiawatha Community Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $26
- Cash Discount Price: $33
- vs. Medicare Baseline: 8.20x 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 820% of the Medicare baseline (a markup of 720%). 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 | $9 - $10 | 284% |
| Aetna | $12 - $27 | 379% |
| Humana | $12 | 379% |
| UnitedHealthcare | $12 - $28 | 379% |
| Ambetter / Centene | $15 | 473% |
| Oscar - All Plans | $25 | 789% |
| Centrus Health Direct - All Plans | $25 | 789% |
| Preferred Hlth - All Plans | $30 | 946% |
| Wppa Providrs Care - All Plans | $31 | 978% |
| Cigna | $31 | 978% |
| Midlands Choice - All Plans | $32 | 1009% |
| Multiplan - All Plans | $32 | 1009% |
| Healthy Blue Mcaid - All Plans | $33 | 1041% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, Urinalysis (automated, with microscopy), Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $33.00. This cash rate is identical to the facility's negotiated median paid amount of $26.00 and matches the state average for this service. When compared to the national Medicare benchmark of $3.17, the facility's cash price represents a significant markup, which is common in commercial billing where rates often exceed 10 times the Medicare baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial negotiated rates for in-network plans can sometimes exceed the cash price due to administrative overhead and contract dynamics.
To optimize costs, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $33.00 rate is lower than the median negotiated rate of $26.00 paid by many insurers listed in the data, such as UnitedHealthcare and Cigna. It is crucial to contact the hospital before scheduling to confirm "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, ensuring they are only charged for services actually rendered and that no unbundled codes or duplicate charges are included.