Blood test, PSA (prostate screen)
Facility: Girard Medical Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $70
- Cash Discount Price: $110
- vs. Medicare Baseline: 3.81x 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 381% of the Medicare baseline (a markup of 281%). 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 | $58 - $190 | 315% |
| Blue Cross Blue Shield | $58 - $70 | 315% |
| Medicare (plans) | $58 - $70 | 315% |
| Aetna | $58 - $350 | 315% |
| Kansas Superior Select-All Plans | $58 - $70 | 315% |
| Ambetter / Centene | $58 - $70 | 315% |
| Humana | $58 - $70 | 315% |
| Multiplan-All Plans | $153 - $185 | 832% |
| Uhhis-All Plans | $157 - $190 | 854% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) procedure at Girard Medical Center in Girard, KS, the facility's cash median price is $110.00, while the median negotiated rate across insurance plans is $70.00. This indicates that paying cash directly may be more cost-effective than using insurance for this specific service, as the negotiated rates are lower than the cash price. Patients should verify their specific plan details, as some high-deductible plans might result in higher out-of-pocket costs if the insurance allowed amount exceeds the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, which could further reduce the final amount owed.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $18.39 for this code. The commercial negotiated rates are significantly higher than the Medicare amount, reflecting the administrative costs and contract dynamics involved in private insurance billing. While the data shows a range of negotiated payments from $58 to $190 depending on the payer, the median of $70.00 provides a reliable baseline for comparison. Consumers are encouraged to request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain discrepancies such as unbundled codes or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients should dispute the charge with their insurer rather than paying immediately, as federal protections may apply.