CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $266
Cash Discount Price: $340
vs. Medicare Baseline: 14.46x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at UPMC Children's Hospital of Pittsburgh is $266. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $340. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 14.46x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$340

Average discount available for prompt cash payment at this facility.

Insurance Median

$266

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: $340 (1849%)

Insurance Median: $266 (1446%)

Cash: $340 (1849% of Medicare)

Ins. Median: $266 (1446% 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 1446% of the Medicare baseline (a markup of 1346%). 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
Aetna	$16 - $312	87%
Health Plan Of Upper Ohio Valley	$18 - $369	98%
Amerihealth Caritas	$20 - $91	109%
Blue Cross Blue Shield	$20 - $152	109%
Cigna	$20 - $312	109%
Upmc Health Plan	$56 - $117	305%
Health Partners Plans (Jefferson Health Plan)	$94	511%
UnitedHealthcare	$97 - $266	527%
Highmark Wholecare (Prev Gateway)	$98	533%
Pa Health & Wellness	$99	538%
Geisinger	$100 - $255	544%
Intergroup	$369 - $482	2007%
Coventry/First Health	$454	2469%
Saudi Armed Forces	$454	2469%
Health Payors Organization	$482	2621%
Multiplan	$482	2621%
National Provider Network	$510	2773%
Private Health Care Systems	$510	2773%

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 $340.
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 Children's Hospital of Pittsburgh 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.