Blood test, PSA (prostate screen)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $30
- Cash Discount Price: $84
- vs. Medicare Baseline: 1.63x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $16 - $110 | 87% |
| Humana | $16 - $18 | 87% |
| Medicaid / KanCare | $16 - $31 | 87% |
| Medica Contracted [320239] | $17 | 92% |
| Blue Cross Blue Shield | $17 - $82 | 92% |
| UnitedHealthcare | $17 - $87 | 92% |
| Halo Hcr Inc Hospice [20432] | $18 | 98% |
| Halo Hcr Inc Hospice Contracted [320432] | $18 | 98% |
| Pace Of The Ozarks Contracted [320518] | $18 | 98% |
| Tricare | $18 | 98% |
| Cross Timbers Hospice [20098] | $18 | 98% |
| Dept Of Veteran Affairs Contracted [320106] | $18 | 98% |
| Mercy Hospice Okc [20252] | $18 | 98% |
| Medicare (plans) | $18 | 98% |
| Kindful Hospice Contracted [320434] | $18 | 98% |
| Kindful Hospice [20434] | $18 | 98% |
| Elara Caring Aspire Hospice [20433] | $18 | 98% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $19 | 103% |
| Health Choice Contracted [320166] | $25 | 136% |
| Home State Health Plan Contracted [320187] | $31 | 169% |
| Ambetter / Centene | $31 | 169% |
| Providrs Care Network Contracted [320484] | $35 | 190% |
| United Medical Resources Contracted [320454] | $87 | 473% |
| Cigna | $102 - $105 | 555% |
| Edison Health Solutions Contracted [320502] | $103 | 560% |
| Imagine 360 Contracted [320494] | $103 | 560% |
| Yuzu Health Contracted [320521] | $103 | 560% |
| American Healthcare Alliance Contracted [320020] | $103 | 560% |
| Ebms Contracted [320493] | $103 | 560% |
| Healthlink Contracted [320179] | $103 | 560% |
| Mercy Benefit Admin Contracted [320251] | $103 | 560% |
| Auxiant Contracted [320462] | $103 | 560% |
| Workers Comp [20426] | $103 | 560% |
| Reflect Health Contracted [320492] | $103 | 560% |
| Aither Health Contracted [320449] | $103 | 560% |
| First Health Contracted [320128] | $110 | 598% |
Consumer Guidance & Cost Commentary
For this blood test, PSA (prostate screen) procedure, Mercy Hospital Pittsburg, Inc. has a cash price of $84.00, which is lower than the facility's negotiated rates with most major payers. While the facility's cash rate is significantly below its gross charge of $129.00, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For patients with high-deductible plans, paying the cash price of $84.00 upfront may result in lower out-of-pocket costs compared to having insurance pay a negotiated rate that exceeds the cash amount, especially if the patient has not yet met their deductible. Patients should verify their specific plan's allowed amount before scheduling to determine if the cash price offers the best financial value.
The facility's cash rate of $84.00 is notably lower than the median paid amount of $87.00 and the gross charge of $129.00, but it remains higher than the Medicare benchmark of $18.39. Medicare rates serve as a scientifically validated baseline for the true cost of care, and commercial rates are often marked up significantly above this figure. To ensure you are not overpaying, we recommend requesting an itemized billing audit to review every line item and confirm that no services were unbundled or double-billed, as over 80% of hospital bills contain errors. Additionally, patients should inquire about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window, effectively bypassing the administrative overhead associated with insurance claims processing.