Blood test, PSA (prostate screen)
Facility: Kansas City Orthopaedic Institute
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $48
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.61x 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 261% of the Medicare baseline (a markup of 161%). 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 | $18 | 98% |
| UnitedHealthcare | $18 | 98% |
| Cigna | $18 | 98% |
| Blue Cross Blue Shield | $48 | 261% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, representing a prostate-specific antigen (PSA) blood test, the Kansas City Orthopaedic Institute in Leawood, KS, has a median negotiated rate of $48.00 across four major payers, including Aetna, UnitedHealthcare, Cigna, and Blue Cross Blue Shield. This negotiated rate is significantly higher than the Medicare benchmark of $18.39, reflecting the standard administrative markup and contract dynamics inherent in commercial insurance pricing. While the facility is an Acute Care Hospital owned by physicians, the data indicates no specific cash or median paid amounts were reported for this service, meaning patients with high-deductible plans should verify if paying cash directly could result in a lower out-of-pocket cost compared to their insurance's negotiated rate.
Because commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling any procedures. Hospitals frequently offer fee reductions of 20% to 50% for upfront payments, bypassing the costly claims processing cycle that inflates insurance rates. Additionally, if a patient receives care from an out-of-network provider at this facility, they may face balance billing for the difference between the provider's chargemaster and the insurance allowed amount, though the No Surprises Act provides federal protections against such surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request a full itemized bill rather than accepting a summary invoice, as detailed line-by-line reviews are the most effective way to identify errors, unbundled codes, or services not rendered.