Blood test, PSA (prostate screen)
Facility: William Newton Hospital
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $39
- Cash Discount Price: $108
- vs. Medicare Baseline: 2.12x 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 212% of the Medicare baseline (a markup of 112%). 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 | $2 - $484 | 11% |
| Ambetter / Centene | $4 - $538 | 22% |
| Triwest- All Plans | $4 - $188 | 22% |
| Blue Cross Blue Shield | $4 - $194 | 22% |
| Providrs Care Nexus | $6 - $329 | 33% |
| Providrs Care - All Other Plans | $7 - $377 | 38% |
Consumer Guidance & Cost Commentary
For this blood test at William Newton Hospital in Winfield, KS, the cash price is $108.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this service, offering a clear advantage for patients with high-deductible plans or those without insurance. While commercial payers like UnitedHealthcare and Ambetter / Centene have negotiated rates ranging from $2 to $538, these amounts often exceed the cash price due to administrative costs and contract structures. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket may result in immediate savings compared to the insurance allowed amount, which can sometimes be higher than the cash rate.
To ensure you are not overcharged, it is critical to request an itemized bill before paying, as summary bills often hide unbundled charges or services not rendered. If you receive a balance bill for the difference between the cash price and your insurance payment, you may be eligible for protections under the No Surprises Act, which bans surprise billing for out-of-network services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce the $108.00 cash price by 20% to 50% if paid upfront, bypassing the costly claims processing cycle that inflates commercial rates. Always dispute any unexpected charges in writing rather than accepting summary invoices or verbal assurances to protect your financial interests.