CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: UPMC Somerset

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $65
Cash Discount Price: $113
vs. Medicare Baseline: 3.53x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at UPMC Somerset is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 3.53x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $113 (614%)

Insurance Median: $65 (353%)

Cash: $113 (614% of Medicare)

Ins. Median: $65 (353% 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 353% of the Medicare baseline (a markup of 253%). 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
Amerihealth Caritas	$18 - $28	98%
Blue Cross Blue Shield	$18 - $35	98%
UnitedHealthcare	$18 - $67	98%
Upmc Health Plan	$18 - $95	98%
Upmc Work Partners	$18	98%
Highmark Wholecare (Prev Gateway)	$20 - $31	109%
Cbhnp	$24	131%
Ccbhn	$24	131%
Geisinger	$34 - $76	185%
Aetna	$73 - $77	397%
Multiplan	$92 - $125	500%
Galaxy Health Plan	$119 - $125	647%
Humana	$137 - $144	745%

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 $113.
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 UPMC Somerset 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.