CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: North Carolina Baptist Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $60
Cash Discount Price: $89
vs. Medicare Baseline: 3.26x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at North Carolina Baptist Hospital is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 3.26x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $89 (484%)

Insurance Median: $60 (326%)

Cash: $89 (484% of Medicare)

Ins. Median: $60 (326% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 326% of the Medicare baseline (a markup of 226%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$18 - $156	98%
Apex	$18	98%
Blue Cross Blue Shield	$18 - $68	98%
Cigna	$18 - $110	98%
Devoted	$18	98%
Healthteam	$18	98%
UnitedHealthcare	$18 - $63	98%
Wellcare	$18 - $34	98%
Humana	$19 - $100	103%
Medicare (plans)	$19	103%
Liberty	$21	114%
Medcost	$32 - $122	174%
Amerihealth	$33 - $43	179%
Carolina Complete	$33	179%
Health Blue	$33	179%
Partners	$33	179%
Alliance	$34	185%
Trillium	$34	185%
Vaya	$34	185%
Ambetter / Centene	$39 - $41	212%
Oscar	$52 - $66	283%
Directnet	$102 - $108	555%
Cone Health	$121 - $128	658%
Healthgram	$121 - $128	658%
First Carolina Care	$138 - $146	750%
Private Healthcare Systems	$142 - $150	772%
Multiplan	$156 - $165	848%

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 $89.
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 North Carolina Baptist Hospital 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.