CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Margaretville Memorial Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $59
Cash Discount Price: $127
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Margaretville Memorial Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 3.21x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$18.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $18.39 (100%)

Cash / Self-Pay: $127 (691%)

Insurance Median: $59 (321%)

Cash: $127 (691% of Medicare)

Ins. Median: $59 (321% of 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 321% of the Medicare baseline (a markup of 221%). 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
UnitedHealthcare	$28 - $56	152%
Oxford	$28	152%
Aetna	$50 - $127	272%
Hamaspik (McR)	$56	305%
Medicare (plans)	$56 - $84	305%
Blue Cross Blue Shield	$56 - $144	305%
Mvp Gold (McR)	$56	305%
Affinity By Molina McR	$59	321%
Cdphp	$61	332%
Mvp	$78	424%
Emblem Ghi/Hip Ppo/Cbp	$79	430%
Mvp Exchange	$83	451%
Emblem Select Care (Exchange)	$86	468%
Oxford Exchange	$89	484%
Magnacare Standard	$89	484%
Mvp Hmo/Ppo	$92	500%
Todays Options	$92	500%
Emblem Ghi/Hip Hmo/Epo/Pos	$102	555%
Multiplan	$104	566%
First Health	$114	620%
Self-Pay	$156	848%
Magnacare Preferred	$502	2730%

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 $127.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84153.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Margaretville Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 84153.
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.