CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Tomah Memorial Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $35
Cash Discount Price: $59
vs. Medicare Baseline: 11.04x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Tomah Memorial Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 11.04x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $59 (1861%)

Insurance Median: $35 (1104%)

Cash: $59 (1861% of Medicare)

Ins. Median: $35 (1104% 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 1104% of the Medicare baseline (a markup of 1004%). 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	$3	95%
Blue Cross Blue Shield	$4 - $95	126%
Independent Care Mcaid	$4	126%
Managed Hlth Mcaid - All Plans	$4	126%
Quartz Mcaid	$4	126%
Security Hp Mcaid	$4	126%
Group Hlth Mcr Adv - All Plans	$35	1104%
Humana	$35 - $95	1104%
Independent Care Mcr - All Other Plans	$35	1104%
Quartz Mcr Adv	$35	1104%
Security Hp Mcr Adv	$35	1104%
UnitedHealthcare	$35 - $97	1104%
Aetna	$67 - $88	2114%
Cigna	$78 - $100	2461%
Security Hp Comm - All Other Plans	$88	2776%
Quartz Comm - All Other Plans	$93	2934%
The Alliance - All Plans	$96	3028%

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 $59.
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 Tomah Memorial 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.