CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Mountain West Medical Center

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $109
Cash Discount Price: $101
vs. Medicare Baseline: 5.93x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Mountain West Medical Center is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 5.93x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $101 (549%)

Insurance Median: $109 (593%)

Cash: $101 (549% of Medicare)

Ins. Median: $109 (593% 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 593% of the Medicare baseline (a markup of 493%). 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
Select Health McR Adv	$18	98%
Blue Cross Blue Shield	$18 - $20	98%
Medicare (plans)	$23	125%
Pehp-All Plans	$24 - $38	131%
Wise/Motivhealth-All Plans	$86 - $133	468%
U of Ut-All Plans	$86 - $133	468%
Cigna	$94 - $145	511%
Dmba-All Plans	$96 - $147	522%
Aetna	$100 - $153	544%
Select Health-All Other Plans	$100 - $153	544%
UnitedHealthcare	$102 - $157	555%
Multiplan Primary Network-All Other Plans	$105 - $161	571%
Emi-All Plans	$113 - $174	614%
Humana	$113 - $174	614%
Multiplan Complimentary Network	$122 - $188	663%

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 $101.
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 Mountain West Medical Center 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.