CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $20
Cash Discount Price: $171
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at UMass Memorial Healthalliance Hospitals is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 1.09x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$171

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$18.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $18.39 (100%)

Cash / Self-Pay: $171 (930%)

Insurance Median: $20 (109%)

Cash: $171 (930% of Medicare)

Ins. Median: $20 (109% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Institution [10406]	$16 - $91	87%
Masshealth [20302]	$16	87%
Medicaid / KanCare	$16 - $20	87%
Cigna	$18 - $71	98%
Medicare (plans)	$18	98%
Tufts Dual [10111]	$18	98%
Tufts Us Family [11203]	$18	98%
Aetna	$19 - $112	103%
Blue Cross Blue Shield	$19 - $58	103%
Commonwealth Care Mcr [10115]	$19	103%
Fallon Mcr Supp [20202]	$19	103%
Harvard Pilgrim Mcr [10106]	$19	103%
Mgb Mcr [10124]	$19	103%
Tufts Mcr [10112]	$19	103%
UnitedHealthcare	$19 - $171	103%
Champva [11001]	$20	109%
Senior Whole Health [10110]	$20	109%
Correctional Care [11003]	$25 - $29	136%
Workers Compensation [20501]	$26	141%
Tufts Connectorcare [10507]	$31	169%
Tufts [11201]	$40	218%
Wellpoint [11112]	$48	261%
Hne [11108]	$95	517%
First Health Network [11120]	$128	696%
Multiplan [11109]	$128	696%
Fallon Connectorcare [10503]	$143	778%
Connecticare [11105]	$171	930%
Fallon Carelon Hlth [28]	$171	930%
Fallon Mcaid Carelon Hlth [29]	$171	930%
Grants [20507]	$171	930%
Hsno/Free Care [10801]	$294	1599%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $171.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84153.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 84153.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.