CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Tops Surgical Specialty Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $23
Cash Discount Price: $137
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Tops Surgical Specialty Hospital is $23. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 1.25x the Medicare baseline. Located in 17080 Red Oak Drive, Houston, TX.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

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: $137 (745%)

Insurance Median: $23 (125%)

Cash: $137 (745% of Medicare)

Ins. Median: $23 (125% 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.

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	$15 - $22	82%
Blue Cross Blue Shield	$19 - $30	103%
Oscar Health Plan	$20	109%
Cigna	$23 - $24	125%
Ambetter / Centene	$26 - $4,848	141%
Health Net	$28	152%
Aetna	$102 - $173	555%

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 $137.
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 Tops Surgical Specialty 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.