Urinalysis (automated, with microscopy)
Facility: Fredonia Regional Hospital
Billing Code: 81001 (CPT)
- CPT Billing Code: 81001
- Insurance Median: $32
- Cash Discount Price: $35
- vs. Medicare Baseline: 10.09x 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 1009% of the Medicare baseline (a markup of 909%). 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 |
|---|---|---|
| UnitedHealthcare | $1 - $32 | 32% |
| Blue Cross Blue Shield | $10 - $18 | 315% |
| Aetna | $18 - $32 | 568% |
| Veterans Programs - All Plans | $18 | 568% |
| Cigna | $32 | 1009% |
| Meritain-All Plans | $32 | 1009% |
| Reserve National-All Plans | $32 | 1009% |
Consumer Guidance & Cost Commentary
For the CPT code 81001, representing an automated urinalysis with microscopy, the cash median price at Fredonia Regional Hospital in Kansas is $35.00. This cash rate is identical to the facility's negotiated median of $32.00 and the state average, indicating that paying out-of-pocket or through a self-pay arrangement yields the same cost as the standard insurance negotiated rate for this procedure. While commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $10 to $32 depending on the specific plan, the cash price remains a stable benchmark. For patients with high-deductible plans, this cash rate may be more favorable than the negotiated rate if the insurance allowed amount exceeds $35.00, though the data shows the negotiated rate is generally lower or equal to the cash price.
To ensure you receive the most accurate billing, it is critical to request an itemized bill before paying, as summary bills often obscure individual charges and may include unbundled codes or services not rendered. If you choose to pay directly, ask the hospital about prompt-pay discounts, which can reduce the total cost by 20% to 50% if settled upfront, bypassing the administrative overhead associated with insurance claims. Additionally, while the facility is a Critical Access Hospital with government local ownership, always verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if your deductible has not been met or if ancillary services are billed separately.