Blood test, PSA (prostate screen)
Facility: Ellsworth County Medical Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $93
- Cash Discount Price: $127
- vs. Medicare Baseline: 5.06x 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 506% of the Medicare baseline (a markup of 406%). 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 | $15 - $98 | 82% |
| Triwest -All Plans | $15 - $98 | 82% |
| Healthy Blue Mcr Adv | $15 - $98 | 82% |
| Humana | $15 - $199 | 82% |
| UnitedHealthcare | $20 - $209 | 109% |
| Aetna | $28 - $188 | 152% |
| First Health - All Plans | $28 - $188 | 152% |
| Cigna | $29 - $199 | 158% |
| Medicaid / KanCare | $31 - $209 | 169% |
| Coventry Mcaid-All Plans | $31 - $209 | 169% |
| Healthy Blue Mcaid- All Other Plans | $31 - $209 | 169% |
| Providers Care-Wppa-All Plans | $46 - $314 | 250% |
| Blue Cross Blue Shield | $64 - $67 | 348% |
Consumer Guidance & Cost Commentary
For this prostate screening test (CPT 84153) at Ellsworth County Medical Center, the cash price is $127.00, which matches the facility's cash median. This rate is significantly lower than the negotiated rates charged to most insurance payers, with many plans paying between $93.00 and $209.00. While commercial insurance contracts often result in higher allowed amounts due to administrative costs and network tiering, patients with high-deductible plans may find the cash price more affordable if their out-of-pocket costs exceed the $127.00 cash rate. To maximize savings, patients should verify their specific plan's deductible status before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront.
The facility's pricing is evaluated against federal benchmarks, where the Medicare amount for this service is $18.39. The cash price of $127.00 represents a markup of 5.1 times the Medicare rate, which is consistent with the typical range of 120% to 150% of Medicare considered fair for commercial pricing. It is important to note that comparing discounts to the hospital's gross charges is misleading; the true baseline for evaluating cost is the Medicare rate. Additionally, patients should request an itemized bill to ensure no errors, such as unbundled codes or charges for services not rendered, are included, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.