Blood test, PSA (prostate screen)
Facility: Great Plains Of Sabetha
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $95
- Cash Discount Price: $101
- vs. Medicare Baseline: 5.17x 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 517% of the Medicare baseline (a markup of 417%). 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 |
|---|---|---|
| Celtic Mcr Adv | $49 - $55 | 266% |
| Aetna | $50 - $107 | 272% |
| Celtic Comm Exchange-All Other Plans | $62 - $69 | 337% |
| Great West Healthcare-All Plans | $81 - $90 | 440% |
| UnitedHealthcare | $88 - $106 | 479% |
| Multiplan-Phcs-All Plans | $90 - $101 | 489% |
| Century/Wppa/Providers-All Plans | $90 - $101 | 489% |
| Humana | $90 - $101 | 489% |
| Cigna | $90 - $101 | 489% |
| Federated Mutual Ins-All Plans | $91 - $102 | 495% |
| Medicaid / KanCare | $95 - $106 | 517% |
| Blue Cross Blue Shield | $95 - $106 | 517% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 84153) at Great Plains Of Sabetha in Sabetha, Kansas, the cash price is $101.00, which matches the facility's median negotiated rate of $95.00 and the cash median of $101.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this specific case, the cash price is comparable to the median negotiated rate of $95.00, suggesting that paying out-of-pocket might be more cost-effective than relying on insurance, particularly for those with high-deductible plans where the insurer's allowed amount could still result in significant out-of-pocket costs.
The Medicare benchmark for this service is $18.39, which serves as a critical baseline for evaluating pricing fairness. Commercial rates, including the facility's cash price of $101.00, are significantly higher than the Medicare rate, reflecting the standard markup in the healthcare system where commercial rates often range from 200% to 300% of Medicare amounts. Patients should request a detailed, itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered. Additionally, since the facility offers prompt-pay discounts for upfront payment, patients should inquire about self-pay rates before scheduling to avoid potential balance billing, which is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act.