CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Kenmore Mercy Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $19
Cash Discount Price: $18
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Kenmore Mercy Hospital is $19. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 1.03x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

$19

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: $18 (98%)

Insurance Median: $19 (103%)

Cash: $18 (98% of Medicare)

Ins. Median: $19 (103% 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
Independent Health [100165]	$14 - $19	76%
Iha First Choice [800001]	$14	76%
Independent Health Essential [100166]	$16	87%
Medicaid / KanCare	$16 - $20	87%
Tricare	$18	98%
Federal Workers Compensation [500100]	$18	98%
Cigna	$18	98%
Tuscarora Nation [550120]	$18	98%
Hospice [550001]	$18	98%
Fallon Health [450115]	$18	98%
Univera Healthcare Essential [100170]	$18 - $22	98%
Champ VA [700002]	$18	98%
Catholic Health Life Pace [400005]	$18	98%
Blue Cross Blue Shield	$18 - $41	98%
Medicare (plans)	$18 - $19	98%
Seneca Nation [450119]	$18	98%
Excellus Rochester McD [350117]	$18	98%
VA Veterans Affairs [700001]	$18	98%
Covid19 Hrsa [45013]	$18	98%
UnitedHealthcare	$18 - $23	98%
Crime Victims [100176]	$18	98%
Humana	$19	103%
Wellcare Fidelis Dual [450451]	$19	103%
Beacon Essential [350122]	$19	103%
Fidelis Dual Advantage [450120]	$19	103%
Univera Healthcare [100169]	$19 - $27	103%
Aetna	$19	103%
Wellcare [450129]	$19	103%
Fidelis Exchange [100164]	$28	152%
No Fault [114001]	$33	179%
Amerigroup [350102]	$36	196%
Fidelis Essential [100163]	$41	223%
Molina Essential [100167]	$41	223%

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 $18.
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 Kenmore Mercy 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.