Blood test, PSA (prostate screen)
Facility: Wamego Health Center
Billing Code: 84153 (CPT)
- CPT Billing Code: 84153
- Insurance Median: $19
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.03x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $18 | 98% |
| Providrs Care | $18 | 98% |
| Medicaid / KanCare | $19 | 103% |
| Aetna | $19 | 103% |
| Blue Cross Blue Shield | $86 - $216 | 468% |
Consumer Guidance & Cost Commentary
For the blood test, PSA (prostate screen) at Wamego Health Center, the facility's cash median price is $58.00, which is significantly lower than the negotiated rates commercial insurers typically pay. While UnitedHealthcare, Providrs Care, Aetna, and Medicaid/KanCare have fixed negotiated rates ranging from $18 to $19, Blue Cross Blue Shield's negotiated rates vary widely between $86 and $216 across six plans. This variation highlights that being in-network does not guarantee the lowest possible price; some commercial contracts exceed the cash price by more than threefold. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the $58.00 cash rate may be more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the negotiated rate exceeds the patient's deductible threshold.
When comparing this facility's pricing to federal benchmarks, the Medicare amount for this service is $18.39, and the facility's median negotiated rate is $19.00, which is nearly identical to the Medicare benchmark. This suggests the facility is pricing competitively relative to the government's cost-based standard, unlike many commercial contracts that can inflate prices to 200% or more of the Medicare rate. Patients are encouraged to verify their specific plan's allowed amount before scheduling, as some in-network contracts may still result in higher charges than the cash price. Additionally, patients should ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees associated with insurance claims processing.