CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: South Pointe Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $41
Cash Discount Price: $78
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at South Pointe Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 2.23x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $78 (424%)

Insurance Median: $41 (223%)

Cash: $78 (424% of Medicare)

Ins. Median: $41 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
UnitedHealthcare	$16 - $74	87%
Aetna	$18 - $120	98%
Blue Cross Blue Shield	$18 - $78	98%
Buckeye	$18	98%
Caresource	$18	98%
Humana	$18 - $102	98%
Molina	$18	98%
Paramount	$18	98%
Summacare	$18 - $45	98%
The Health Plan	$18 - $72	98%
United	$18 - $28	98%
Upmc	$18 - $72	98%
Valor	$18	98%
Amerihealth	$19	103%
Cigna	$19 - $96	103%
Communicare	$19	103%
Perennial Health	$20	109%
Mmo	$24 - $72	131%
Cc Ehp	$32 - $48	174%
Oscar	$36 - $46	196%
Aultcare	$52	283%
Ohcp	$58	315%
Omas	$60	326%
Ohio Healthy	$65	353%
Healthsmart	$66	359%
Php	$72	392%
Gms	$84	457%
Medical Benefit Corp	$84	457%
Quality Care Partners	$84	457%
Consociate Health	$90	489%
Frontpath	$108	587%
Managed Care Services	$108	587%
Multiplan	$108	587%
Tertiary Care Network	$108	587%
Three Rivers	$108	587%

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 $78.
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 South Pointe 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.