Blood test, PSA (prostate screen)
Facility: Northeast Regional Medical Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $213
- Cash Discount Price: $237
- vs. Medicare Baseline: 11.58x 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 1158% of the Medicare baseline (a markup of 1058%). 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 |
|---|---|---|
| Node Champva | $16 | 87% |
| Tricare | $16 | 87% |
| Medicaid / KanCare | $17 - $27 | 92% |
| Blue Access | $18 | 98% |
| Blue Prefrerred | $18 | 98% |
| Blue Cross Blue Shield | $18 - $183 | 98% |
| Medicare (plans) | $18 | 98% |
| Veterans Eval Services | $18 | 98% |
| Node Hospice Non Par Agree | $18 | 98% |
| Node VA | $18 | 98% |
| Blue Pathway/Pathway X | $18 | 98% |
| UnitedHealthcare | $18 - $450 | 98% |
| Node Devoted Health McR Adv | $19 | 103% |
| Us Department of Labor | $23 | 125% |
| Centurion Correctional | $23 | 125% |
| Home State Exchange | $33 | 179% |
| Naphcare | $35 | 190% |
| Immergrun | $37 | 201% |
| Self Pay | $144 - $330 | 783% |
| Cigna | $204 - $234 | 1109% |
| Aetna | $223 - $500 | 1213% |
| Access Health Services, LLC | $390 | 2121% |
| Multiplan | $450 - $480 | 2447% |
| Healthlink | $450 - $480 | 2447% |
| Coventry Wc | $480 | 2610% |
Consumer Guidance & Cost Commentary
For patients paying out of pocket, the most important fact to know is that the cash price for this blood test, PSA (prostate screen) procedure is $237. While the hospital's full chargemaster lists the gross price at $600, paying directly often provides the lowest possible rate. It is crucial to verify if the facility offers a "self-pay" discount before scheduling, as the data shows a self-pay range of $144 to $450, meaning a savvy patient could potentially pay significantly less than the standard cash rate of $237.
Broader rate analysis shows that this cash price of $237 is higher than the state average of $18.39, though it remains well below the facility's gross charge. When insurance is involved, the situation changes; for example, UnitedHealthcare negotiates a high range of $16 to $450, and Blue Cross Blue Shield negotiates between $18 and $183. Because commercial negotiated rates often include administrative overhead and can exceed cash prices, patients with high-deductible plans should consider paying cash upfront to avoid balance billing or unexpected costs. Always request a prompt-pay discount or a waiver of insurance submission before your visit to ensure you are not inadvertently agreeing to higher in-network rates or facing balance billing for out-of-network ancillary services.