CMS Price Transparency Data
Blood test, PSA (prostate screen)
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 84153 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 84153
- Insurance Median: $161
- Cash Discount Price: $162
- vs. Medicare Baseline: 8.75x Medicare
The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Saint Joseph Regional Medical Center - Plymouth is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 8.75x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$162
Average discount available for prompt cash payment at this facility.
Insurance Median
$161
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: $162 (881%)
Insurance Median: $161 (875%)
Cash: $162 (881% of Medicare)
Ins. Median: $161 (875% 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 875% of the Medicare baseline (a markup of 775%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $10 - $123 | 54% |
| Blue Cross Blue Shield | $10 - $37 | 54% |
| Medicaid / KanCare | $10 - $18 | 54% |
| UnitedHealthcare | $10 - $161 | 54% |
| Managed Health Services - Indiana | $18 | 98% |
| Mdwise | $18 | 98% |
| Medicare (plans) | $18 - $19 | 98% |
| Meridian Complete | $18 | 98% |
| Pace-Trinity Health | $18 | 98% |
| County Coroner | $19 | 103% |
| Provider Partners Health Plan Of Indiana | $20 | 109% |
| Auxiant | $28 - $209 | 152% |
| Caresource | $28 | 152% |
| Physicians Health Plan Northern Indiana Health Insurance | $28 - $56 | 152% |
| St Joseph County Hlth Dpt | $28 | 152% |
| Siho Insurance Services | $29 | 158% |
| Key Benefit Administrator | $33 - $177 | 179% |
| Allied Benefit Systems | $35 - $164 | 190% |
| Blue Benefit Administrators Of Massachusetts | $37 | 201% |
| Blue Care Network | $37 | 201% |
| Blue Distinction Transplant | $37 | 201% |
| Blue Shield - Ca | $37 | 201% |
| Blue Shield - Id (Regence) | $37 | 201% |
| Blue Shield - Ny Highmark Northeastern | $37 | 201% |
| Blue Shield - Ny Highmark Western | $37 | 201% |
| Blue Shield - Pa (Highmark) | $37 | 201% |
| Blue Shield - Wa (Regence) | $37 | 201% |
| Custom Design Benefits | $40 | 218% |
| Plain Church Group | $67 - $68 | 364% |
| Asr Health Benefits | $121 - $123 | 658% |
| Christian Brother Services | $121 - $123 | 658% |
| Employee Benefit Management | $121 - $123 | 658% |
| Medical Mutual | $121 - $123 | 658% |
| Meritain | $121 - $123 | 658% |
| Preferred One | $121 - $123 | 658% |
| Rural Carrier Health Benefit Plan | $121 - $123 | 658% |
| Webtpa | $121 - $123 | 658% |
| Notre Dame Athletic Association | $136 - $139 | 740% |
| Wc Notre Dame | $136 - $139 | 740% |
| Luminare Health (Detroit) | $141 - $151 | 767% |
| Ameriben | $148 - $151 | 805% |
| Geha | $157 - $161 | 854% |
| Healthscope | $157 - $161 | 854% |
| Student Insurance Cma | $157 - $161 | 854% |
| Encore Health | $173 - $177 | 941% |
| Indiana Criminal Justice Inst | $173 - $177 | 941% |
| Western & Southern Financial Group | $173 - $177 | 941% |
| Cigna | $178 - $181 | 968% |
| Group Administrators | $178 - $181 | 968% |
| Health Partners | $178 - $181 | 968% |
| Mvp | $178 - $181 | 968% |
| Prairie States | $178 - $181 | 968% |
| Priority Health | $178 - $181 | 968% |
| Professional Benefit Administrators | $178 - $181 | 968% |
| Sagamore Health Network | $178 - $194 | 968% |
| Sisco Benefits | $178 - $181 | 968% |
| Unified Group Services | $178 - $181 | 968% |
| Goshen Preferred Network | $190 - $217 | 1033% |
| Signature Care | $205 - $209 | 1115% |
| Allied National Global Care | $222 - $227 | 1207% |
| Asrm - Reliance Standard Life Insurance | $222 - $227 | 1207% |
| Avmed Health Plan | $222 - $227 | 1207% |
| Christian Care Ministry | $222 - $227 | 1207% |
| Dean Health | $222 - $227 | 1207% |
| Fallon Health | $222 - $227 | 1207% |
| Family Life Insurance Company | $222 - $227 | 1207% |
| Freedom Life Insurance Company | $222 - $227 | 1207% |
| Ghc Scw | $222 - $227 | 1207% |
| International Benefit Administrators | $222 - $227 | 1207% |
| Lifetime Benefit Solutions | $222 - $227 | 1207% |
| Manhattan Life | $222 - $227 | 1207% |
| Medi Share | $222 - $227 | 1207% |
| Multiplan | $222 - $227 | 1207% |
| Pai | $222 - $227 | 1207% |
| Pan-American Life | $222 - $227 | 1207% |
| Paramount Hmo | $222 - $227 | 1207% |
| Phcs | $222 - $227 | 1207% |
| Philadelphia American Life Insurance | $222 - $227 | 1207% |
| Trinity Health Share | $222 - $227 | 1207% |
| Bankers Life Casualty | $247 - $252 | 1343% |
| Bureau Of Disability | $247 - $252 | 1343% |
| Wc Align Network | $247 - $252 | 1343% |