Blood test, PSA (prostate screen)
Facility: Cloud County Health Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $171
- Cash Discount Price: $126
- vs. Medicare Baseline: 9.30x 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 930% of the Medicare baseline (a markup of 830%). 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 |
|---|---|---|
| Aetna | $162 - $168 | 881% |
| Mpi-All Plans | $171 | 930% |
| Pponext-All Plans | $171 | 930% |
| Health Partners - All Plans | $171 | 930% |
Consumer Guidance & Cost Commentary
For the prostate screening service (CPT 84153) at Cloud County Health Center in Concordia, KS, the facility's cash price of $126.00 is lower than the median negotiated rate of $171.00 paid by most insurers, including Aetna, Mpi-All Plans, and others. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that the cash price is also lower than the Medicare benchmark of $18.39 when adjusted for the facility's specific cost basis, though commercial rates typically range between 200% and 300% of Medicare; in this instance, the cash rate represents a significant discount relative to the standard insurance allowed amounts.
Consumers should be aware that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it does not automatically apply to all ancillary lab services or prevent potential discrepancies in itemized billing. To ensure you are not overcharged, always request a full itemized bill before finalizing payment, as summary invoices can obscure individual code costs and lead to errors such as double-billing or unbundled charges. Additionally, if you choose to pay out-of-pocket, ask the billing department about "prompt-pay" discounts, which can further reduce the $126.00 cash price by offering immediate liquidity incentives, ensuring you receive the most favorable rate available before the service is rendered.