CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Southcoast Hospitals Group

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $72
Cash Discount Price: $115
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Southcoast Hospitals Group is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.51x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $115 (240%)

Insurance Median: $72 (151%)

Cash: $115 (240% of Medicare)

Ins. Median: $72 (151% 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
Mass General Brigham Health Plan Commercial [10122	$35	73%
Wellsense Health Plan Clarity Connectorcare & Meta	$48 - $50	100%
Blue Cross Blue Shield	$52 - $66	109%
Aetna	$55 - $179	115%
Evercare [1010304]	$55	115%
Medicare (plans)	$55 - $66	115%
Tufts Senior Care Options [1010315]	$55	115%
UnitedHealthcare	$55 - $74	115%
Wellsense Health Plan Senior Care Options [1020208	$55	115%
Commonwealth Care Alliance [1080501]	$56 - $57	117%
Eternal Health [1010322]	$60	125%
Harvard Pilgrim [1010602]	$72	151%
Fallon [1000114]	$77	161%
Tufts [1010701]	$93 - $98	194%
Mass General Brigham Health Plan Connectorcare [10	$126 - $132	263%
Group Insurance Service Center [1013001]	$134 - $141	280%
Innovative Health Plan [1025001]	$134 - $141	280%
Priority Health [1015001]	$134 - $141	280%
PHCS [1000125]	$145 - $153	303%
Wellpoint [1000102]	$145 - $153	303%
Cigna	$147 - $155	307%
First Health [1000130]	$170 - $179	355%
Tufts Health Public Plans [1010213]	$412	861%

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 $115.
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 Southcoast Hospitals Group 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.