Blood test, PSA (prostate screen)
Facility: Graham County Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $70
- Cash Discount Price: $98
- vs. Medicare Baseline: 3.81x 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 381% of the Medicare baseline (a markup of 281%). 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 | $16 - $104 | 87% |
| Medicaid / KanCare | $29 | 158% |
| Medicare (plans) | $64 - $82 | 348% |
| Blue Cross Blue Shield | $67 | 364% |
| Celtic Commercial-All Other Plans | $70 - $91 | 381% |
| Wppa (Providers Care)-All Plans | $81 - $104 | 440% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) procedure at Graham County Hospital in Hill City, Kansas, the cash price is $98.00, which matches the facility's cash median. This cash rate is significantly higher than the state average of $83.00, meaning patients paying out-of-pocket are paying more than the typical negotiated rate in Kansas. While commercial insurance plans like UnitedHealthcare and Celtic Commercial-All Other Plans have negotiated rates ranging from $16 to $104, these amounts often exceed the cash price due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the $98.00 cash price upfront might be more cost-effective than relying on insurance, as the insurer's allowed amount could be higher than the cash rate.
To minimize costs, it is essential to verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these can reduce the final bill by 20% to 50%. Although the facility is a Critical Access Hospital owned by the local government, patients should request an itemized billing audit to ensure no errors exist, as over 80% of hospital bills contain mistakes. Additionally, while the Medicare benchmark for this service is $18.39, commercial rates are often marked up significantly above this baseline; however, the facility's negotiated rates generally align closer to fair pricing than the gross charges. Always check your specific plan's deductible status and allowed amounts before using insurance, as assuming in-network coverage guarantees the lowest price can lead to unexpected costs if the insurer's negotiated rate exceeds the cash price.