CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Pioneer Memorial Hospital - Cah

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $130
Cash Discount Price: $153
vs. Medicare Baseline: 6.73x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Pioneer Memorial Hospital - Cah is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $153. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 6.73x the Medicare baseline. Located in 315 N Washington Ave Post Office Box 368, Viborg, SD.

Cash / Self-Pay

$153

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $153 (792%)

Insurance Median: $130 (673%)

Cash: $153 (792% of Medicare)

Ins. Median: $130 (673% 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 673% of the Medicare baseline (a markup of 573%). 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
UnitedHealthcare	$54 - $129	280%
Aetna	$121	627%
Health Partners	$127	658%
United Medical Resources	$129	668%
Medica	$130	673%
Cigna	$130	673%
Dakotacare	$130	673%
Avera Health Plan	$130	673%
Sanford Health Plan	$138	715%
Blue Cross Blue Shield	$147	761%

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 $153.
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 Pioneer Memorial Hospital - Cah 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.