CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Charleston Area Medical Center

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $130
Cash Discount Price: $238
vs. Medicare Baseline: 6.73x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Charleston Area Medical Center is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $238. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 6.73x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$238

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: $238 (1233%)

Insurance Median: $130 (673%)

Cash: $238 (1233% 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
Aetna	$15 - $243	78%
Unicare Health Plan of West Virginia Inc.	$18 - $62	93%
The Health Plan of West Virginia Inc.	$18 - $241	93%
Blue Cross Blue Shield	$19 - $226	98%
Choicecare Network	$19 - $243	98%
Optimum Choice Inc.	$19 - $62	98%
Triwest VA	$19 - $60	98%
UnitedHealthcare	$20 - $243	104%
West Virginia Senior Advantage Inc.	$20 - $65	104%
Integrated Medical Solutions	$38 - $121	197%
Naphcare	$39 - $124	202%
Caresource	$48 - $155	249%
Tricare	$137 - $149	709%
City of Charleston	$171 - $186	886%
Cigna	$212 - $231	1098%
Three Rivers Providers Network	$221 - $241	1144%
Multiplan	$223 - $243	1155%
Healthsmart	$223 - $243	1155%

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 $238.
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 Charleston Area Medical Center 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.