Blood test, PSA (prostate screen)
Facility: Stormont Vail Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $55
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.99x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ambetter / Centene | $19 | 103% |
| Blue Cross Blue Shield | $19 - $68 | 103% |
| UnitedHealthcare | $19 | 103% |
Consumer Guidance & Cost Commentary
For the blood test code 84153 (PSA prostate screen) at Stormont Vail Hospital in Topeka, KS, the commercial negotiated rates range from $19 to $68, with a median negotiated amount of $55.00. This facility's pricing is significantly higher than the state average, as the median paid amount of $10,413.00 reflects the specific insurance plan details rather than a general market rate. While the facility is a voluntary non-profit acute care hospital with a 4-star rating, patients should be aware that cash-pay options are not listed for this specific service. However, it is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can sometimes result in lower out-of-pocket costs compared to standard insurance billing, especially for those with high-deductible plans.
When evaluating costs, it is important to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster list. The Medicare amount for this procedure is $18.39, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates often average between 200% and 300% of the Medicare rate, though fair pricing is typically defined as 120% to 150% of this benchmark. Since the facility's median negotiated rate of $55.00 is well above the Medicare amount, patients should verify their specific plan's deductible status before scheduling, as they may be responsible for the full negotiated amount if their deductible has not yet been met. Additionally, if the patient's insurance allows a higher rate than the cash price, paying out-of-pocket upfront could potentially