Blood test, PSA (prostate screen)
Facility: St Luke Hospital & Living Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $89
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.84x 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 484% of the Medicare baseline (a markup of 384%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $89 | 484% |
| Va Ccn | $89 | 484% |
| Humana | $89 | 484% |
| Kansas Department Of Health And Environment | $89 | 484% |
| Bluestem Pace | $89 | 484% |
| UnitedHealthcare | $89 | 484% |
| Ambetter / Centene | $90 | 489% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, representing a prostate-specific antigen (PSA) blood test, St. Luke Hospital & Living Center in Marion, KS, has a negotiated rate of $89.00 across seven payers, including Blue Cross Blue Shield and UnitedHealthcare. This negotiated amount is significantly higher than the Medicare benchmark of $18.39, reflecting a markup of 4.8 times the federal rate. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and network tiering, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the facility's cash rate is not listed in the data but is typically lower than the negotiated insurance amount. It is important to note that commercial rates can vary widely by payer, and this facility's rates are specific to its contracts with these seven insurers.
To ensure you are receiving the most accurate pricing, it is recommended to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs and may include unbundled charges or services not rendered. Additionally, patients should inquire about prompt-pay discounts, which can reduce the total bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle associated with insurance billing. Since the facility is a Critical Access Hospital in Marion, KS, and operates under a government hospital district, verifying the specific self-pay or prompt-pay terms directly with the billing department is essential to avoid unexpected costs or balance billing scenarios.