CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Hackensack Meridian Mountainside Medical

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $29
Cash Discount Price: $22
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Hackensack Meridian Mountainside Medical is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 1.50x the Medicare baseline. Located in 1 Bay Avenue, Montclair, NJ.

Cash / Self-Pay

$22

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

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: $22 (114%)

Insurance Median: $29 (150%)

Cash: $22 (114% of Medicare)

Ins. Median: $29 (150% 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.

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	$4	21%
Healthscope Benefits [2290]	$4 - $29	21%
Aetna	$5	26%
Selecthealth [3740]	$14	73%
Medicare (plans)	$14	73%
Wtc Healthcare Sme Karna [8005]	$14	73%
Lucent Health [6000]	$14	73%
Worker's Comp [2125]	$14 - $32	73%
Create Flex / Select [3580]	$14	73%
Black Lung [6055]	$14	73%
Healthcare Highways [2210]	$14 - $29	73%
Web Tpa [2115]	$14	73%
Oncology Patient Assistance Programs [2295]	$14	73%
First Health [1375]	$26 - $29	135%
Cigna	$28	145%
Healthnet [1495]	$29	150%
Mutual of Omaha [1685]	$29	150%
PHCS [1780]	$29	150%
Resource One Administrators [2815]	$29	150%
Pan American Life Insurance Co [1770]	$29	150%
Planned Administrators Inc [2360]	$29	150%
Universal Fidelity [2085]	$29	150%
Gilsbar [1425]	$29	150%
Hometown Health [2155]	$29	150%
Administrative Concepts [1005]	$29	150%
Healthfirst [2395]	$29	150%
Trustmark [2030]	$29	150%
Healthcost Solutions [2415]	$29	150%
Pba [1775]	$29	150%
Mayo Clinic Health Solutions [2280]	$29	150%
Allied National Global Care [1035]	$29	150%
Multiplan [1680]	$29	150%
New Era Life Insurance Company [1705]	$29	150%
Emblem Health [2430]	$32	166%
Humana	$32	166%
Blue Cross Blue Shield	$34	176%
Amerihealth [3520]	$35	181%
Mva [1690]	$35	181%

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 $22.
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 Hackensack Meridian Mountainside Medical 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.