CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Jfk University Medical Center

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $116
Cash Discount Price: $49
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Jfk University Medical Center is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 2.42x the Medicare baseline. Located in 65 James Street, Edison, NJ.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $49 (102%)

Insurance Median: $116 (242%)

Cash: $49 (102% of Medicare)

Ins. Median: $116 (242% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 242% of the Medicare baseline (a markup of 142%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$27 - $148	56%
Horizon	$27 - $153	56%
UnitedHealthcare	$28 - $137	59%
Clover	$30	63%
Seoul Medical Group	$35	73%
Amerigroup	$46 - $51	96%
Vaccn	$46 - $51	96%
Wellcare	$46 - $51	96%
United Community/Americhoice	$48 - $54	100%
Blue Cross Blue Shield	$51	107%
Karna	$51	107%
Oxford - Jri@Oumc	$83	173%
Activecare First McO	$116	242%
Intergroup	$116	242%
Bergen Risk	$124	259%
Prime Health	$132	276%
Oxford	$137	286%
Multiplan - PHCS	$140	293%
Brighton Health Plan	$148	309%
Qualcare	$153	320%
Amerihealth	$156	326%
Cigna	$159	332%

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 $49.
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 Jfk University 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.