Blood test, PSA (prostate screen)
Facility: Smith County Memorial Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $81
- Cash Discount Price: $95
- vs. Medicare Baseline: 4.40x 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 440% of the Medicare baseline (a markup of 340%). 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 |
|---|---|---|
| Medicaid / KanCare | $60 - $105 | 326% |
| Blue Cross Blue Shield | $67 | 364% |
| Multiplan-All Plans | $76 - $94 | 413% |
| Wppa-All Plans | $80 - $99 | 435% |
| Midlands Choice-All Plans | $81 - $100 | 440% |
| UnitedHealthcare | $81 - $100 | 440% |
| Health Partners Of Ks Ppo-All Plans | $81 - $100 | 440% |
Consumer Guidance & Cost Commentary
For the CPT code 84153 (Blood test, PSA), Smith County Memorial Hospital in Smith Center, KS, lists a cash median price of $95.00, which matches the facility's gross charge. While the facility is a Critical Access Hospital owned by the local government, patients should note that cash payments can sometimes be more cost-effective than using insurance if the negotiated rate exceeds the cash price. In this case, the median negotiated rate across seven payers is $81.00, which is lower than the cash price; however, patients with high-deductible plans should still verify their specific deductible status before relying on insurance, as they may face higher out-of-pocket costs if their plan has not yet met its threshold.
When comparing this service to federal benchmarks, the Medicare amount for this procedure is $18.39. The facility's cash rate of $95.00 represents a significant markup relative to the Medicare baseline, illustrating how commercial rates can differ substantially from the government's cost-based standard. To ensure you are not overcharged, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Additionally, if you receive a balance bill from an out-of-network provider, remember that the No Surprises Act generally prohibits these surprise charges for emergency care and non-emergency services at in-network facilities, so you should dispute any unexpected bills in writing rather than paying immediately.