CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Rush Memorial Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $27
Cash Discount Price: $31
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Rush Memorial Hospital is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.56x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $31 (65%)

Insurance Median: $27 (56%)

Cash: $31 (65% of Medicare)

Ins. Median: $27 (56% 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
Health Net	$12	25%
Caresource McR Adv	$13	27%
Viant Beech St McR Adv	$13	27%
Blue Cross Blue Shield	$13 - $30	27%
Humana	$13 - $38	27%
Aetna	$13 - $38	27%
Today's Option McR Adv-All Plans	$13	27%
My True Advantage - All Plans	$13	27%
UnitedHealthcare	$13 - $33	27%
Caresource Marketplace-All Other Plans	$20	42%
Cigna	$33	69%
Phcs-All Plans	$33	69%
Consumers Life Ins-All Plans	$37	77%
Coventry/First Health-All Plans	$37	77%
Sagamore-All Plans	$38	79%
Community Health Alliance-All Plans	$38	79%
Multiplan-All Plans	$38	79%
Siho-All Plans	$38	79%
Encore Health Services-All Plans	$40	84%

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 $31.
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 Rush Memorial 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.