CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Roundup Memorial Healthcare

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $33
Cash Discount Price: $34
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Roundup Memorial Healthcare is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.69x the Medicare baseline. Located in 1202 3Rd St W, Roundup, MT.

Cash / Self-Pay

$34

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $34 (71%)

Insurance Median: $33 (69%)

Cash: $34 (71% of Medicare)

Ins. Median: $33 (69% 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
VA Ccn - All Plans	$17 - $526	36%
Tricare	$17 - $253	36%
Geha-All Plans	$28	59%
Blue Cross Blue Shield	$31 - $34	65%
Ebms (Rmhn Network) - All Plans	$32	67%
Pacific Source-All Plans	$32	67%
First Choice-All Plans	$33	69%
Montana Health Co-Op Ppo/Pos - All Plans	$33	69%
Multiplan-All Plans	$33	69%
UnitedHealthcare	$34	71%

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 $34.
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 Roundup Memorial Healthcare 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.