CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Holy Cross Hospital - Salt Lake

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $193
Cash Discount Price: $156
vs. Medicare Baseline: 9.99x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Holy Cross Hospital - Salt Lake is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 9.99x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $156 (808%)

Insurance Median: $193 (999%)

Cash: $156 (808% of Medicare)

Ins. Median: $193 (999% 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 999% of the Medicare baseline (a markup of 899%). 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	$13 - $234	67%
Uuhp	$16 - $212	83%
Rocky Mountain Health Plan	$16	83%
Medicaid / KanCare	$16	83%
Health Choice	$16	83%
Cigna	$16 - $312	83%
Denver Health	$16	83%
Medicare (plans)	$19	98%
Humana	$19	98%
Centura Employee Plan	$23	119%
UnitedHealthcare	$23	119%
Employer Direct Healthcare	$24	124%
Motivhealth	$25	129%
Molina	$39 - $168	202%
Pehp	$167 - $391	865%
Aetna	$173 - $330	896%
Wise	$203 - $207	1051%
Deseret Mutual Benefit Administrators	$240	1243%
Select Health	$258	1336%
Multiplan	$269 - $355	1393%
Emi Health	$391	2025%

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 $156.
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 Holy Cross Hospital - Salt Lake 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.