Blood test, PSA (prostate screen)
Facility: Phillips County Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $75
- Cash Discount Price: $72
- vs. Medicare Baseline: 4.08x 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 408% of the Medicare baseline (a markup of 308%). 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 |
|---|---|---|
| UnitedHealthcare | $60 - $94 | 326% |
| Blue Cross Blue Shield | $61 - $76 | 332% |
| Health Partners-All Plans | $75 - $94 | 408% |
| Medicaid / KanCare | $75 - $94 | 408% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, representing a prostate-specific antigen (PSA) blood test, the cash median price at Phillips County Hospital in Phillipsburg, KS, is $72.00, while the facility's negotiated rates with insurance payers average $75.00. This facility, a Critical Access Hospital with local government ownership, operates in Phillips County, Kansas (Zip 67661). While specific county and state average data points were not provided in the source material, it is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. For patients with high-deductible plans, paying the cash price of $72.00 upfront can sometimes be more cost-effective than the insurance negotiated rate of $75.00, provided the patient has not yet met their deductible.
Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the out-of-pocket cost. Additionally, if you receive an itemized bill, ensure it includes a line-by-line breakdown of CPT codes to identify any errors, double-billing, or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute. When comparing this facility's pricing to Medicare benchmarks, the Medicare amount for this service is $18.39. Commercial rates are typically marked up significantly above this baseline; fair pricing is generally defined as 120% to 150% of the Medicare rate, whereas many commercial contracts average 200% to 300% of Medicare. Always request an item