Blood test, PSA (prostate screen)
Facility: Holton Community Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $89
- Cash Discount Price: $92
- vs. Medicare Baseline: 4.84x 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 484% of the Medicare baseline (a markup of 384%). 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 |
|---|---|---|
| UnitedHealthcare | $50 - $123 | 272% |
| Humana | $50 - $66 | 272% |
| Aetna | $50 - $123 | 272% |
| Kansas Superior Select - All Plans | $51 - $66 | 277% |
| Blue Cross Blue Shield | $67 | 364% |
| Preferred Health Fn Select - All Other Plans | $78 - $102 | 424% |
| Preferred Health Professionals | $78 - $102 | 424% |
| Preferred Health Freedom | $78 - $102 | 424% |
| Wppa Providers - All Plans | $89 - $117 | 484% |
| Medicaid / KanCare | $94 - $123 | 511% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) procedure at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $92.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is below the state average of $102.00, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash price. For instance, UnitedHealthcare, Aetna, and Medicaid/KanCare all have negotiated ranges that reach up to $123.00, significantly higher than the cash rate. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
It is important to understand that commercial insurance rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark. The Medicare amount for this service is $18.39, meaning the facility's cash price of $92.00 is roughly five times the Medicare rate, illustrating the markup common in commercial billing. If you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider charges the difference between their full list price and what your insurance allowed. However, the No Surprises Act protects patients from balance billing for emergency care and non-emergency services at in-network facilities. If you receive a surprise bill, do not pay immediately; instead, dispute the charge with your insurer and request a formal audit to ensure compliance with federal