Blood test, PSA (prostate screen)
Facility: Nemaha Valley Community Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $96
- Cash Discount Price: $167
- vs. Medicare Baseline: 5.22x 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 522% of the Medicare baseline (a markup of 422%). 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 |
|---|---|---|
| Va Ccn - All Plans | $34 | 185% |
| Humana | $81 | 440% |
| Aetna | $82 - $157 | 446% |
| Celtic Comm Exch - All Plans | $90 | 489% |
| Partners Direct Health - All Plans | $96 | 522% |
| Multiplan - All Plans | $166 | 903% |
| Midlands Choice - All Plans | $176 | 957% |
| Health Partners - All Plans | $176 | 957% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) procedure at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $167.00, which is lower than the facility's gross charge of $185.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates vary significantly; for example, Aetna plans have a range from $82 to $157, and Multiplan plans are set at $166. In cases where your insurance deductible has not yet been met or your plan has a high deductible, paying the cash price of $167.00 upfront may be more cost-effective than facing a negotiated rate that exceeds this amount, provided you secure a prompt-pay discount before the claim is submitted.
The facility's negotiated rate of $96.00 sits below the gross charge but remains higher than the cash option, illustrating how administrative processing costs can inflate commercial rates. It is important to note that Medicare allows only $18.39 for this service, meaning commercial rates are substantially higher than the federal benchmark. To ensure you receive the best possible price, patients should explicitly request a self-pay classification and prompt-pay discount prior to scheduling, as billing systems often default to insurance processing once a card is on file. Additionally, if you receive a surprise bill, you should request a formal itemized audit to verify that no unbundled codes or services not rendered have been included, as over 80% of hospital bills contain errors that can be corrected through written dispute.