Blood test, PSA (prostate screen)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $68
- Cash Discount Price: $136
- vs. Medicare Baseline: 3.70x 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 370% of the Medicare baseline (a markup of 270%). 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 | $39 - $112 | 212% |
| UnitedHealthcare | $49 - $85 | 266% |
| Blue Cross Blue Shield | $68 | 370% |
Consumer Guidance & Cost Commentary
For the prostate screening service (CPT 84153) at Community Memorial Healthcare in Marysville, KS, the cash price is $136.00, which matches the cash median for this procedure in the state. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $39 to $112, these amounts are often higher than the cash price due to administrative costs and contract structures. If you have a high-deductible plan, paying the cash price of $136.00 upfront may be more cost-effective than relying on insurance, which could result in a higher out-of-pocket expense if your deductible has not yet been met. We recommend asking the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if you settle the bill immediately.
When evaluating this charge, it is important to compare it against the Medicare benchmark rather than the hospital's gross list price. The Medicare reimbursement rate for this code is $18.39, meaning the cash price of $136.00 represents a significant markup above the federal baseline. This comparison helps reveal the true cost of the service and prevents confusion caused by inflated chargemaster lists. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should always request a detailed, itemized bill before paying to ensure no errors or unbundled charges are included. Verifying your specific plan's allowed amount and checking for any potential discounts can help you avoid unexpected costs.