Blood test, PSA (prostate screen)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $90
- Cash Discount Price: $90
- vs. Medicare Baseline: 4.89x 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 489% of the Medicare baseline (a markup of 389%). 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 |
|---|---|---|
| Va Ccn - All Plans | $19 | 103% |
| Humana | $52 | 283% |
| Tricare | $56 | 305% |
| Aetna | $66 - $95 | 359% |
| Medicaid / KanCare | $66 - $106 | 359% |
| UnitedHealthcare | $66 - $106 | 359% |
| Ambetter / Centene | $72 | 392% |
| Blue Cross Blue Shield | $93 | 506% |
| Health Partners - All Plans | $101 | 549% |
| Healthy Blue Mcaid - All Plans | $106 | 576% |
Consumer Guidance & Cost Commentary
For the CPT code 84153 (Blood test, PSA), Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a cash median price of $90.00, which is lower than the facility's negotiated rates for most payers. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial insurance contracts often result in higher allowed amounts; for instance, Aetna and UnitedHealthcare have negotiated ranges starting at $66 and extending up to $106, while Medicaid/KanCare and Healthy Blue Medicaid also range from $66 to $106. This dynamic suggests that for individuals with high-deductible plans, paying the cash price of $90.00 upfront could be more cost-effective than relying on insurance, which may only cover a portion of the negotiated rate after deductibles are met.
To ensure you are not overcharged, it is advisable to request a prompt-pay discount before scheduling your visit, as hospitals often offer significant reductions for upfront payments that bypass the administrative costs of insurance billing. If you receive a bill after using insurance, you should request an itemized audit to verify that no balance billing or unbundled charges are included, particularly since federal protections like the No Surprises Act may apply if out-of-network ancillary services were involved. Comparing these specific rates to the broader market context, the cash price of $90.00 aligns with the median negotiated rate of $90.00 found in the data, but remains below the gross charge of $106.00, providing a clear baseline for negotiation if your insurance payment is lower than expected.