CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Sublette County Health

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $144
Cash Discount Price: $152
vs. Medicare Baseline: 7.46x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Sublette County Health is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 7.46x the Medicare baseline. Located in 615 E Hennick St, Pinedale, WY.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $152 (787%)

Insurance Median: $144 (746%)

Cash: $152 (787% of Medicare)

Ins. Median: $144 (746% 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 746% of the Medicare baseline (a markup of 646%). 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	$127	658%
First Health - All Plans	$135	699%
Cigna	$152	787%
Blue Advantage - All Plans	$160	829%

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 $152.
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 Sublette County Health 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.