Blood test, PSA (prostate screen)
Facility: Regional Medical Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $870
- Cash Discount Price: $118
- vs. Medicare Baseline: 47.31x 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 $18.39 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 4731% of the Medicare baseline (a markup of 4631%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 4731% |
Consumer Guidance & Cost Commentary
For a blood test, PSA (prostate screen) at Regional Medical Center in Manchester, the cash median price is $118. This facility is a government-owned Critical Access Hospital in Iowa, and while their negotiated rate with Medical Associates Health Plan - Tri is $870, the cash price of $118 is significantly lower than the commercial rate. Given that the Medicare benchmark for this service is $18.39, the cash price represents a substantial markup over the federal baseline, yet it remains the most direct price for patients without insurance. In this specific case, the cash rate is notably lower than the state average of $56 for the median paid amount, suggesting that paying out-of-pocket could be a financially prudent option for those with high deductibles or no coverage, provided they verify if "self-pay" or "prompt-pay" discounts are available upfront.
Patients should be aware that the $870 negotiated rate charged by the insurance plan is vastly higher than the cash price, illustrating that an in-network status does not always guarantee the lowest possible cost. While the facility's rating is 4 out of 5, the pricing structure here demonstrates that commercial contracts can inflate costs to over four times the cash rate. To ensure you are not overcharged, it is critical to request an itemized bill before payment to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. If you receive a summary bill, demand a full CPT-coded statement to verify the exact charges against the $118 cash median and avoid paying for unnecessary administrative markups or duplicate services.