CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Good Samaritan Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $19
Cash Discount Price: $15
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Good Samaritan Hospital is $19. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 1.03x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$15

Average discount available for prompt cash payment at this facility.

Insurance Median

$19

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: $15 (82%)

Insurance Median: $19 (103%)

Cash: $15 (82% of Medicare)

Ins. Median: $19 (103% 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.

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
First Health	$2 - $28	11%
Humana	$2 - $19	11%
Multiplan	$2 - $22	11%
Nx Health Network	$2 - $17	11%
Sutter Select	$2 - $17	11%
Cigna	$3 - $191	16%
Healthsmart	$3 - $22	16%
Intercontinental Corporation	$3 - $22	16%
Pha Pacific Health Alliance	$3 - $22	16%
Ppo Next	$3 - $22	16%
Medcare Partners	$4	22%
Santa Clara Family Health Plan	$5 - $18	27%
Health Net	$6 - $22	33%
United	$7 - $19	38%
Aetna	$18 - $94	98%
Affinity Medical Group	$18	98%
Alignment Health Plan	$18	98%
Blue Cross Blue Shield	$18 - $97	98%
Central Health Plan	$18	98%
Clever Care Of Golden State	$18	98%
Easy Choice Health Plan	$18	98%
Managed Health Network	$18	98%
On Lok Senior Health	$18	98%
Palo Alto Medical	$18 - $24	98%
Scan Health Plan	$18	98%
Triwest Healthcare Alliance	$18	98%
University Healthcare	$18	98%
Vitality Health Plan	$18	98%
Blue Shield	$19 - $34	103%
Care1St Health Plan	$19	103%
Corvel Corporation	$21	114%
Physicians Medical Group	$21	114%
Affinity Medical Group Comm	$24	131%
Canopy	$33	179%
Bright Health	$37	201%

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 $15.
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 Good Samaritan 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.