CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Garnet Health Medical Center

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $24
Cash Discount Price: $65
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Garnet Health Medical Center is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 1.31x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$24

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: $65 (353%)

Insurance Median: $24 (131%)

Cash: $65 (353% of Medicare)

Ins. Median: $24 (131% 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
Cigna	$15	82%
Aetna	$18 - $24	98%
UnitedHealthcare	$18	98%
Fidelis	$19	103%
Wellcare	$19	103%
Local 1199	$24	131%
Rojw	$32	174%
Northwell Direct	$38	207%
Geisinger Health Plan	$46	250%
Blue Cross Blue Shield	$52	283%
Mvp	$61	332%

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 $65.
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 Garnet Health Medical Center 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.