CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Melrosewakefield Healthcare

Billing Code: G0009 (HCPCS)

The BaseRate · fair price high confidence

A fair price for this

$58

about 1.2× the $48 Medicare rate · typically $47–$119

modeled estimate · not a bill or quote

What this hospital charges insurers

$130

Well above the fair price

about $72 over the fair price · 2.7× Medicare

Medicare pays $48 Fair price $58 This hospital $130 Cash price $112 Hospital's list price $160

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

Highest price of the 9 MA hospitals we have prices for — worth calling around.

Cheapest $47 Priciest $130

Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.

A fair price for a Pneumonia vaccine injection is about $58 (about 1.2× the $48 Medicare rate). Melrosewakefield Healthcare charges insurers about $130, or about $112 in cash — well above the fair price. Located in Melrose, MA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $58. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$131 - $160	274%
Blue Cross Blue Shieldmajor	$53 - $160	111%
Aetnamajor	$56 - $173	117%
Cignamajor	$80 - $130	167%
AmeriHealth	$56	117%
AvMed	$56	117%
GEHA	$56	117%
Harvard Pilgrim	$119 - $131	249%
Tufts Health Plan	$60 - $130	125%
+ 105 smaller / regional plans	$53 - $531

Government programs also on file: Medicare, Medicaid.

Excludes 12 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 112), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the HCPCS code on your bill matches exactly: G0009.

Insurance Before you use insurance

Call your insurance company to confirm Melrosewakefield Healthcare is in-network.
Ask your insurer whether prior approval is required for HCPCS code G0009.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Melrosewakefield Healthcare

Compare: Pneumonia vaccine injection at other MA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.