Blood test, PSA (prostate screen)
Facility: Nmc Health
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $113
- Cash Discount Price: $115
- vs. Medicare Baseline: 6.14x 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 614% of the Medicare baseline (a markup of 514%). 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 |
|---|---|---|
| Aetna | $58 - $167 | 315% |
| Blue Cross Blue Shield | $68 | 370% |
| Wppa | $69 - $112 | 375% |
| Occunet | $76 - $122 | 413% |
| Medincrease Health Plan | $82 - $132 | 446% |
| Samaritan Ministries International | $82 - $132 | 446% |
| Prime Health Services | $95 - $152 | 517% |
| UnitedHealthcare | $113 - $183 | 614% |
| Cigna | $120 - $193 | 653% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) service at Nmc Health in Newton, Kansas, the facility's cash price of $115.00 is lower than the state average, which is $165.00. While commercial insurance plans like Aetna and Blue Cross Blue Shield have negotiated rates ranging from $58 to $167, these amounts often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rates can sometimes be significantly higher than the self-pay amount. It is important to verify the specific allowed amount with your insurer before scheduling, as in-network rates vary widely even within the same facility.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, comparing the facility's pricing to the Medicare benchmark of $18.39 reveals that the cash rate of $115.00 represents a markup of 6.1 times the Medicare amount, which is consistent with typical commercial pricing dynamics. If you receive a bill after using insurance, request a full itemized audit to ensure no errors exist, as over 80% of hospital bills contain discrepancies. Finally, be aware that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, so you should not feel pressured to pay unexpected differences immediately.