CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Hospital for Special Surgery

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $130
Cash Discount Price: $281
vs. Medicare Baseline: 7.07x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Hospital for Special Surgery is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 7.07x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $281 (1528%)

Insurance Median: $130 (707%)

Cash: $281 (1528% of Medicare)

Ins. Median: $130 (707% 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 707% of the Medicare baseline (a markup of 607%). 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	$18 - $272	98%
UnitedHealthcare	$25 - $155	136%
Fidelis Essential [1323]	$41	223%
Aetna	$43 - $197	234%
Affinity By Molina Health Plan [1005]	$43 - $122	234%
Christian Brothers [1034]	$43 - $197	234%
Connecticare [1039]	$43 - $268	234%
Emblem Health [1043]	$43 - $268	234%
Harvard Pilgrim [1057]	$43 - $155	234%
Medicare (plans)	$43	234%
Meritain Health [1085]	$43 - $197	234%
Nippon Life [1092]	$43 - $197	234%
Oxford [1096]	$43 - $105	234%
Student Resources [1103]	$43 - $128	234%
Webtpa [1356]	$43 - $197	234%
Geha [1053]	$128	696%
Apwu [1016]	$129 - $144	701%
Cigna	$129 - $144	701%
Nalc [1090]	$129 - $144	701%
Qualcare [1101]	$129 - $144	701%
Wellfleet [1361]	$129 - $144	701%

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 $281.
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 Hospital for Special Surgery 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.