CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Atrium Health Pineville

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $82
Cash Discount Price: $104
vs. Medicare Baseline: 4.46x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Atrium Health Pineville is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 4.46x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

$104

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: $104 (566%)

Insurance Median: $82 (446%)

Cash: $104 (566% 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
Aetna	$19 - $172	103%
Cigna	$19 - $140	103%
Humana	$19	103%
UnitedHealthcare	$19 - $98	103%
Alliance	$21 - $23	114%
Amerihealth Caritas	$21 - $23	114%
Carolina Complete Health	$21 - $23	114%
Healthy Blue	$21 - $23	114%
Partners	$21 - $23	114%
Wellcare	$21 - $23	114%
Trillium	$22 - $23	120%
Vaya	$22 - $23	120%
Blue Cross Blue Shield	$23 - $81	125%
Ortho Carolina	$23	125%
Medcost	$41 - $124	223%
Ambetter / Centene	$60 - $75	326%
Employers Health Network	$92 - $110	500%
Physician Reach Out	$104	566%
Magellan	$125	680%
Gmmi	$135	734%
Quik Trip	$135	734%
Choicecare	$150 - $154	816%
Healthgram	$166	903%
Provider Select	$168 - $187	914%
Private Health Care Systems	$170	924%
First Health	$172	935%
Beechstreet	$187	1017%
Multiplan	$191	1039%

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 $104.
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 Atrium Health Pineville 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.