CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: UPMC Northwest

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $78
Cash Discount Price: $97
vs. Medicare Baseline: 4.24x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at UPMC Northwest is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 4.24x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $97 (527%)

Insurance Median: $78 (424%)

Cash: $97 (527% of Medicare)

Ins. Median: $78 (424% 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 424% of the Medicare baseline (a markup of 324%). 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
Upmc Health Plan	$17 - $27	92%
Blue Cross Blue Shield	$18 - $114	98%
Geisinger	$18	98%
Upmc Work Partners	$18	98%
Aetna	$19 - $105	103%
UnitedHealthcare	$19 - $28	103%
Amerihealth Caritas	$20 - $38	109%
Highmark Wholecare (Prev Gateway)	$20 - $36	109%
Pa Health & Wellness	$20 - $42	109%
Cigna	$64 - $105	348%
Intergroup	$105 - $3,704	571%
Coventry/First Health	$113	614%
Health Coalition Partners	$116	631%
Private Health Care Systems	$129	701%
Humana	$137	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 $97.
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 Northwest 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.