CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Mercy St Francis Hospital

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $160
Cash Discount Price: $116
vs. Medicare Baseline: 8.29x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Mercy St Francis Hospital is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 8.29x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$19.31

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $19.31 (100%)

Cash / Self-Pay: $116 (601%)

Insurance Median: $160 (829%)

Cash: $116 (601% of Medicare)

Ins. Median: $160 (829% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $19.31 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 829% of the Medicare baseline (a markup of 729%). 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
Blue Cross Blue Shield	$19 - $173	98%
Medicare (plans)	$20 - $64	104%
Medicaid / KanCare	$24 - $92	124%
UnitedHealthcare	$27 - $169	140%
Indian Health Service Contracted [320198]	$49 - $61	254%
Cigna	$49 - $169	254%
Halo Hcr Inc Hospice [20432]	$49 - $61	254%
Humana	$49 - $160	254%
Mercy Mgd Behavioral Health Contracted [320259]	$49 - $61	254%
Halo Hcr Inc Hospice Contracted [320432]	$49 - $61	254%
Kindful Hospice Contracted [320434]	$49 - $61	254%
Provider Partners Health Plans Contracted [320450]	$49 - $61	254%
Cross Timbers Hospice [20098]	$49 - $61	254%
Dept of Veteran Affairs Contracted [320106]	$49 - $61	254%
Qual Choice Contracted [320325]	$49 - $61	254%
Mercy Hospice Okc [20252]	$49 - $61	254%
Medical Associates Health Contracted [320444]	$49 - $61	254%
Pace of the Ozarks Contracted [320518]	$49 - $61	254%
Elara Caring Aspire Hospice [20433]	$49 - $61	254%
Kindful Hospice [20434]	$49 - $61	254%
Aetna	$49 - $158	254%
Acentra Health Contracted [320527]	$49	254%
Globalhealth Contracted [320145]	$49 - $61	254%
Cherokee Nation Health Serv Contracted [320066]	$49 - $61	254%
Tricare	$61	316%
Healthscope Contracted [320182]	$61 - $81	316%
Administrative Payor Contracted [320005]	$80	414%
Centivo Contracted [320505]	$81 - $103	419%
Home State Health Plan Contracted [320187]	$92	476%
Ambetter / Centene	$92	476%
Novasys Contracted [320285]	$92	476%
Preferred Health Plan Contracted [320522]	$116	601%
Healthlink Contracted [320179]	$116 - $169	601%
Workers Comp [20426]	$142 - $151	735%
Point C Contracted [320238]	$160 - $169	829%
Auxiant Contracted [320462]	$160 - $169	829%
Mercy Benefit Admin Contracted [320251]	$160 - $169	829%
United Medical Resources Contracted [320454]	$160 - $166	829%
Medica Contracted [320239]	$168	870%
Aither Health Contracted [320449]	$169	875%
Private Health Care Systems Contracted [320320]	$169	875%
Show-Me Health Administrators Contracted [320483]	$169	875%
Multiplan Contracted [320270]	$169	875%
Health Systems Inc Contracted [320174]	$169	875%
Reflect Health Contracted [320492]	$169	875%
Imagine 360 Contracted [320494]	$169	875%
Yuzu Health Contracted [320521]	$169	875%
Ebms Contracted [320493]	$169	875%
First Health Contracted [320128]	$169	875%
Insurance System Inc Contracted [320465]	$169	875%
Point C [20238]	$169	875%
Benefit Management Contracted [320052]	$169	875%
Edison Health Solutions Contracted [320502]	$169	875%
Evolutions Health Care Contracted [320124]	$169	875%
USA Managed Care Org Contracted [320429]	$169	875%
90 Degree Benefits Contracted [320436]	$169	875%

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 $116.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0103.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy St Francis Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0103.
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.