Blood test, PSA (prostate screen)
Facility: Kingman Healthcare Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $6
- Cash Discount Price: $6
- vs. Medicare Baseline: 0.33x 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.
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 |
|---|---|---|
| Health Partners | $3 - $152 | 16% |
| Cigna | $3 - $152 | 16% |
| Aetna | $3 - $152 | 16% |
| UnitedHealthcare | $3 - $152 | 16% |
| Wellcare | $5 - $68 | 27% |
| Humana | $5 - $68 | 27% |
| Celtic Insurance Company | $5 - $74 | 27% |
| Medicaid / KanCare | $5 - $74 | 27% |
| Ambetter / Centene | $6 - $74 | 33% |
| Healthy Blue | $18 | 98% |
| Triwest | $19 | 103% |
Consumer Guidance & Cost Commentary
For the CPT code 84153, a blood test for prostate screening, Kingman Healthcare Center in Kansas has a cash median price of $6.00, which is significantly lower than the facility's gross charge of $13.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates vary widely among the 11 participating payers, ranging from $3.00 to $18.00. It is important to note that for patients with high-deductible plans, paying the cash price of $6.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for some commercial payers can exceed the cash amount. Additionally, patients should verify if their specific plan qualifies for a prompt-pay discount, which could further reduce the final bill if paid in full before or shortly after the service.
When evaluating costs, it is crucial to compare these rates against the Medicare benchmark rather than the facility's gross list price. The Medicare amount for this procedure is $18.39, which serves as a scientifically validated baseline for the true cost of delivery. Although the data does not provide specific state or county average comparisons for this exact code, the principle of Medicare benchmarking reveals that commercial negotiated rates often include administrative markups that can inflate the final cost for members. To avoid unexpected balance billing, patients should ensure they understand their network status, as the No Surprises Act protects against out-of-network charges for emergency care and non-emergency services at in-network facilities. Finally, if a bill is received, requesting a detailed itemized audit is the most effective way to identify errors, unbundled codes, or services