CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Craig Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $18
Cash Discount Price: $10
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Craig Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.38x the Medicare baseline. Located in 3425 S Clarkson St, Englewood, CO.

Cash / Self-Pay

$10

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$47.84

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $47.84 (100%)

Cash / Self-Pay: $10 (21%)

Insurance Median: $18 (38%)

Cash: $10 (21% of Medicare)

Ins. Median: $18 (38% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $47.84 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
Cigna	$13	27%
UnitedHealthcare	$13 - $46	27%
Kaiser	$13	27%
Carisk Outcomes	$14	29%
Blue Cross Blue Shield	$14	29%
Zenith	$15	31%
Corvel Worker's Comp	$16	33%
Liberty Mutual Worker's Comp	$16	33%
Paradigm	$16	33%
Aetna	$16	33%
Midwest Employers Casualty	$17	36%
Rocky Mountain Health Plan	$17	36%
Geha/Ppo USA	$18	38%
Fcci Worker's Comp	$18	38%
Great-West Healthcare	$18	38%
Prime Health Services	$18	38%
First Choice Health	$18	38%
Coventry/First Health	$18	38%
General Reinsurance	$19 - $20	40%
Multiplan/Phcs	$19	40%
Provider Network of America	$19	40%
Wyoming Worker's Comp	$19	40%
Three Rivers Provider Network	$19	40%
Focus Worker's Comp	$19	40%
Allstate	$20	42%
Tricare	$20	42%
Up & Up	$21	44%
National Provider Network	$21	44%
Veterans Administration	$39	82%
Cms	$46	96%

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 $10.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0009.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Craig Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0009.
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.