Blood test, PSA (prostate screen)
Facility: Decatur Health
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $96
- Cash Discount Price: $114
- vs. Medicare Baseline: 5.22x 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 522% of the Medicare baseline (a markup of 422%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $76 | 413% |
| UnitedHealthcare | $77 - $96 | 419% |
| Humana | $78 | 424% |
| Blue Cross Blue Shield | $87 | 473% |
| Aetna | $114 - $126 | 620% |
| Midlands Choice- All Plans | $114 | 620% |
| Medicaid / KanCare | $127 | 691% |
Consumer Guidance & Cost Commentary
For this prostate screening test (CPT 84153) at Decatur Health in Oberlin, KS, the facility's cash price of $114.00 is notably higher than the state average of $87.00, though it aligns closely with the county average. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $76 to $126, these figures often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates can sometimes be inflated by up to 200% to 300% of the Medicare benchmark of $18.39.
To secure the best possible rate, it is essential to verify "self-pay" or "prompt-pay" discounts before scheduling, as these can reduce the final bill by 20% to 50% by bypassing costly claims processing. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a detailed, itemized bill to ensure no errors exist, as over 80% of hospital bills contain discrepancies. Comparing the facility's pricing against the Medicare benchmark reveals that while the cash rate is higher than the state median, it remains significantly lower than the gross chargemaster price, offering a transparent baseline for negotiation.