CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Boone County Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $37
Cash Discount Price: $63
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Boone County Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 2.01x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $63 (343%)

Insurance Median: $37 (201%)

Cash: $63 (343% of Medicare)

Ins. Median: $37 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Va Ccn-All Plans	$5 - $24	27%
Choice Care Mcr Adv - All Plans	$11 - $53	60%
Humana	$11 - $116	60%
Iowa Hlth Adv - All Plans	$11 - $53	60%
Mt Carmel Hp - All Plans	$11 - $53	60%
Aetna	$12 - $100	65%
Amerigroup Mcr Adv - All Other Plans	$12 - $53	65%
Iowa Total Care Mcaid - All Plans	$13 - $59	71%
Medicaid / KanCare	$13 - $60	71%
Meridian Mcaid - All Plans	$13 - $58	71%
UnitedHealthcare	$16 - $76	87%
Tricare	$18	98%
Healthsmart Accell Network	$20 - $90	109%
Medical Associates Hp-All Plans	$21 - $97	114%
Healthsmart Ppo - All Other Plans	$22 - $103	120%
Health Alliance-All Plans	$25 - $116	136%
Midlands Choice-All Plans	$26 - $118	141%
Mutually Preferred-All Plans	$27 - $122	147%
Wellmark Hmo	$47	256%
Wellmark Ppo - All Other Plans	$52	283%

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 $63.
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 Boone County 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.