Blood test, PSA (prostate screen)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $41
- Cash Discount Price: $138
- vs. Medicare Baseline: 2.23x 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 223% of the Medicare baseline (a markup of 123%). 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 |
|---|---|---|
| United Medical Resources Contracted [320454] | $15 - $51 | 82% |
| UnitedHealthcare | $15 - $197 | 82% |
| Medicaid / KanCare | $16 - $26 | 87% |
| First Health Contracted [320128] | $16 | 87% |
| Aetna | $16 - $18 | 87% |
| Humana | $16 - $18 | 87% |
| Medica Contracted [320239] | $17 | 92% |
| Blue Cross Blue Shield | $17 - $49 | 92% |
| Kindful Hospice [20434] | $18 | 98% |
| Elara Caring Aspire Hospice [20433] | $18 | 98% |
| Mercy Hospice Okc [20252] | $18 | 98% |
| Mercy Mgd Behavioral Health Contracted [320259] | $18 | 98% |
| Qual Choice Contracted [320325] | $18 | 98% |
| Kindful Hospice Contracted [320434] | $18 | 98% |
| Cherokee Nation Health Serv Contracted [320066] | $18 | 98% |
| Cross Timbers Hospice [20098] | $18 | 98% |
| Tricare | $18 | 98% |
| Pace Of The Ozarks Contracted [320518] | $18 | 98% |
| Cigna | $18 - $105 | 98% |
| Dept Of Veteran Affairs Contracted [320106] | $18 | 98% |
| Globalhealth Contracted [320145] | $18 | 98% |
| Halo Hcr Inc Hospice Contracted [320432] | $18 | 98% |
| Halo Hcr Inc Hospice [20432] | $18 | 98% |
| Medicare (plans) | $18 | 98% |
| Medical Associates Health Contracted [320444] | $18 | 98% |
| Provider Partners Health Plans Contracted [320450] | $20 | 109% |
| Centivo Contracted [320505] | $30 | 163% |
| Providrs Care Network Contracted [320484] | $35 | 190% |
| Insurance System Inc Contracted [320465] | $51 | 277% |
| Benefit Management Contracted [320052] | $51 | 277% |
| Healthscope Contracted [320182] | $51 - $160 | 277% |
| Health Systems Inc Contracted [320174] | $51 | 277% |
| Point C Contracted [320238] | $51 - $160 | 277% |
| Show-Me Health Administrators Contracted [320483] | $113 | 614% |
| Mercy Benefit Admin Contracted [320251] | $113 - $149 | 614% |
| Ebms Contracted [320493] | $149 | 810% |
| Imagine 360 Contracted [320494] | $149 | 810% |
| Reflect Health Contracted [320492] | $149 | 810% |
| Yuzu Health Contracted [320521] | $149 | 810% |
| Auxiant Contracted [320462] | $149 - $160 | 810% |
| Edison Health Solutions Contracted [320502] | $149 | 810% |
| American Healthcare Alliance Contracted [320020] | $149 | 810% |
| Aither Health Contracted [320449] | $149 | 810% |
| Preferred Health Plan Contracted [320522] | $160 | 870% |
| Federal Medical Center Contracted [320127] | $160 | 870% |
| Healthlink Contracted [320179] | $160 | 870% |
| Compcare Of The Ozarks Contracted [320437] | $168 | 914% |
| Workers Comp [20426] | $170 | 924% |
| Private Health Care Systems Contracted [320320] | $197 | 1071% |
| Multiplan [20270] | $202 | 1098% |
| Multiplan Contracted [320270] | $202 | 1098% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) procedure at Mercy Specialty Hospital Southeast Kansas, the facility's cash price of $138.00 is significantly lower than the median negotiated rates paid by most insurance plans, which range from $15 to $197 across 51 different payers. While the facility's cash rate is also lower than the state average for this service, patients with high-deductible plans may find it beneficial to pay the cash price directly, as many commercial contracts exceed this amount. It is important to note that while the facility is a voluntary non-profit acute care hospital in Galena, KS, and offers a cash rate of $138.00, the actual amount paid by insurance varies widely depending on the specific plan; for instance, Medicaid/KanCare plans average $16 to $26, whereas some commercial contracts like Healthscope and Point C range up to $160.
Patients should be aware that insurance negotiated rates often include administrative costs and contract premiums that can make them higher than the direct cash price, even though these rates are contractually capped. If you have insurance, you should verify your specific deductible status before scheduling, as you may be responsible for paying the full negotiated amount if your plan has not yet met its threshold. Additionally, if you choose to pay out-of-pocket, you can often request a "prompt-pay" discount or self-pay rate from the billing department, which may further reduce the cost below the listed cash median. Always ensure you receive an itemized bill to confirm that no balance billing or unbundled charges are applied, especially since federal protections like the No Surprises Act may limit unexpected out-of-network billing for services rendered