CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Riverview Medical Center

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $77
Cash Discount Price: $51
vs. Medicare Baseline: 1.61x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Riverview Medical Center is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.61x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $51 (107%)

Insurance Median: $77 (161%)

Cash: $51 (107% of Medicare)

Ins. Median: $77 (161% 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
Aetna	$14 - $89	29%
Clover	$18	38%
Seoul Medical Group	$21	44%
Karna	$50	105%
Blue Cross Blue Shield	$51	107%
Vaccn	$51	107%
Wellcare	$51	107%
United Community/Americhoice	$54	113%
UnitedHealthcare	$58 - $80	121%
Oxford	$60	125%
Horizon	$63 - $80	132%
Bergen Risk	$74	155%
Qualcare	$77 - $87	161%
Cigna	$79 - $95	165%
Activecare First McO	$84	176%
Multiplan - PHCS	$84	176%
Amerihealth	$86 - $97	180%
Brighton Health Plan	$89	186%

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 $51.
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 Riverview Medical Center 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.