Blood test, PSA (prostate screen)
Facility: Clay County Medical Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $99
- Cash Discount Price: $106
- vs. Medicare Baseline: 5.38x 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 538% of the Medicare baseline (a markup of 438%). 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 | $96 - $100 | 522% |
| Wppa/Providrs Care- All Plans | $96 - $100 | 522% |
| Multiplan- All Plans | $99 - $102 | 538% |
| UnitedHealthcare | $99 - $102 | 538% |
| Health Partners - All Plans | $99 - $102 | 538% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, representing a prostate-specific antigen (PSA) blood test, Clay County Medical Center in Clay Center, KS, lists a cash median price of $106.00. This cash rate is notably higher than the state average for this service, which is $99.00. While the facility's negotiated rates for in-network payers like Aetna and UnitedHealthcare range between $96 and $102, these amounts remain close to the cash price, suggesting that for patients with high-deductible plans, paying the cash rate directly may result in lower out-of-pocket costs compared to insurance processing. Given that the facility is a Critical Access Hospital with government-local ownership, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final bill.
The Medicare benchmark for this procedure is $18.39, which serves as a critical baseline for evaluating the facility's pricing structure. The facility's cash rate of $106.00 represents a significant markup relative to the federal government's fixed reimbursement rate, highlighting the difference between the true cost of care and the commercial charges. To ensure you are not overpaying, it is essential to request an itemized billing audit rather than accepting a summary bill, as hospitals may bundle services or include charges for items not rendered. By comparing your specific insurance allowed amount against the Medicare rate and seeking written confirmation of all line items, you can identify potential errors or unbundled codes that could be negotiated down to align more closely with fair market value.