Blood test, PSA (prostate screen)
Facility: Ellinwood District Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $73
- Cash Discount Price: $89
- vs. Medicare Baseline: 3.97x 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 397% of the Medicare baseline (a markup of 297%). 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 | $62 - $84 | 337% |
| Cigna | $62 - $84 | 337% |
| Blue Cross Blue Shield | $62 - $84 | 337% |
| Humana | $62 - $84 | 337% |
| UnitedHealthcare | $62 - $84 | 337% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) service at Ellinwood District Hospital, the cash median price is $89.00, which is lower than the negotiated rates of $73.00 paid by major insurers like Aetna, Cigna, and UnitedHealthcare. This price difference highlights a common billing scenario where paying out-of-pocket can be more cost-effective than using insurance, especially for patients with high-deductible plans who may face higher out-of-pocket costs if their insurance negotiated rate exceeds the cash price. While the facility is a government-owned Critical Access Hospital in Ellinwood, KS, patients should verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract dynamics, sometimes reaching 200% to 300% of the Medicare benchmark rate of $18.39 for this procedure, whereas fair pricing is typically defined as 120% to 150% of that baseline. If you receive a bill from an out-of-network provider or encounter unexpected charges, you have protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services at in-network facilities. To ensure you are not overcharged, always request a full itemized bill before paying, as summary invoices can hide errors or unbundled codes, and dispute any discrepancies in writing to avoid paying for services not rendered or charges that were incorrectly calculated.