CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: St Mary Medical Center

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $64
Cash Discount Price: $111
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at St Mary Medical Center is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 3.48x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $111 (604%)

Insurance Median: $64 (348%)

Cash: $111 (604% of Medicare)

Ins. Median: $64 (348% 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 348% of the Medicare baseline (a markup of 248%). 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
Pace-Trinity Health	$10 - $33	54%
Blue Cross Blue Shield	$18 - $229	98%
Aetna	$19 - $293	103%
Align Senior Care	$19	103%
Cigna	$19 - $98	103%
Medicare (plans)	$19 - $33	103%
Health America Advantra	$22	120%
Medicaid / KanCare	$28 - $58	152%
Ambetter / Centene	$33	179%
Jefferson Health Plan Commercial	$33	179%
Oscar	$33	179%
Prime Healthcare	$33	179%
Homestead Health Plans Woods Center	$36	196%
UnitedHealthcare	$40 - $159	218%
Group Pension Administrators	$41	223%
Reedman Toll	$41	223%
Geha	$43 - $134	234%
Blue Shield - Pa (Highmark)	$50	272%
Keystone First	$58	315%
Keystone First Chip	$58	315%
Amerihealth	$89	484%
Blue Shield - Ca	$89	484%
Blue Shield - Id (Regence)	$89	484%
Blue Shield - Ny Highmark Western	$89	484%
Blue Shield - Wa (Regence)	$89	484%
Meritain	$93 - $293	506%
Multiplan	$94 - $296	511%
Prime Health Services	$94 - $296	511%
Upmc Health Plan	$98	533%
Webtpa	$98	533%
Galaxy Health Network	$100 - $313	544%
Three Rivers Provider Network	$100 - $313	544%

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 $111.
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 St Mary 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.