Blood test, PSA (prostate screen)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $120
- Cash Discount Price: $138
- vs. Medicare Baseline: 6.53x 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 653% of the Medicare baseline (a markup of 553%). 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 |
|---|---|---|
| Tricare | $71 - $163 | 386% |
| Humana | $81 - $186 | 440% |
| Aetna | $82 - $204 | 446% |
| Hpk-All Plans | $84 - $194 | 457% |
| UnitedHealthcare | $84 - $194 | 457% |
| Medicaid / KanCare | $89 - $204 | 484% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, representing a prostate-specific antigen (PSA) blood test, Medicine Lodge Memorial Hospital in Medicine Lodge, KS, lists a cash price of $138.00. This cash rate is identical to the facility's median negotiated rate of $138.00, which is notably higher than the state average of $89.00. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $84 to $204, patients with high-deductible plans may find paying the full cash price of $138.00 more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate. Because the facility is a Critical Access Hospital owned by a Government Hospital District, patients should proactively ask about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can bypass the administrative costs and higher negotiated rates typically associated with insurance billing.
The Medicare benchmark for this service is $18.39, which serves as a critical baseline for evaluating the facility's pricing structure. The facility's cash price of $138.00 represents a significant markup relative to this federal rate, illustrating the difference between the true cost of care and the commercial chargemaster. Under federal protections such as the No Surprises Act, patients should be aware that balance billing for out-of-network services at in-network facilities is generally prohibited, though they must still verify that ancillary services like laboratory tests are covered under their plan. To ensure accuracy and avoid unexpected charges, consumers are advised to request a full itemized bill containing specific CPT codes rather than accepting summary invoices, and to dispute any