CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Lexington Memorial Hospital Inc

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $82
Cash Discount Price: $93
vs. Medicare Baseline: 4.46x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Lexington Memorial Hospital Inc is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 4.46x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $93 (506%)

Insurance Median: $82 (446%)

Cash: $93 (506% of Medicare)

Ins. Median: $82 (446% 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 446% of the Medicare baseline (a markup of 346%). 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
Blue Cross Blue Shield	$27 - $44	147%
Ambetter / Centene	$28	152%
Amerihealth	$28 - $33	152%
Carolina Complete	$33	179%
Healthy Blue	$33	179%
Partners	$33	179%
Alliance	$34	185%
Trillium	$34	185%
UnitedHealthcare	$34 - $83	185%
Vaya	$34	185%
Wellcare	$34	185%
Medcost	$41 - $124	223%
Aetna	$53 - $172	288%
Oscar	$60 - $82	326%
Cigna	$81 - $82	440%
Directnet	$110	598%
Healthgram Lexington Home Brands	$134	729%
Healthgram	$149	810%
Private Healthcare Systems	$153	832%
Beechstreet	$164	892%
Humana	$164	892%
Multiplan	$167	908%
National Provider Network	$167	908%

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 $93.
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 Lexington Memorial Hospital Inc 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.