CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Hackensack Meridian Health Pascack Valley Medical

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $83
Cash Discount Price: $63
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Hackensack Meridian Health Pascack Valley Medical is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.73x the Medicare baseline. Located in 250 Old Hook Road, Westwood, NJ.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $63 (132%)

Insurance Median: $83 (173%)

Cash: $63 (132% of Medicare)

Ins. Median: $83 (173% 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
Healthscope Benefits [2290]	$8	17%
UnitedHealthcare	$8 - $91	17%
Medicaid / KanCare	$14 - $15	29%
Medicare (plans)	$18	38%
Aetna	$21 - $85	44%
Black Lung [6055]	$40	84%
Commercial Generic [1285]	$40	84%
Create Flex / Select [3580]	$40	84%
Healthcare Highways [2210]	$40	84%
Horizon [3625]	$40 - $91	84%
Lucent Health [6000]	$40	84%
Oncology Patient Assistance Programs [2295]	$40	84%
Selecthealth [3740]	$40	84%
Web Tpa [2115]	$40 - $85	84%
Worker's Comp [2125]	$40 - $88	84%
Wtc Healthcare Sme Karna [8005]	$40	84%
Geha [1415]	$44	92%
Qualcare [3725]	$82 - $95	171%
1199 Seiu Benefit Fund [3505]	$85	178%
Allied Benefit Systems Inc [1030]	$85	178%
Meritain Health [1655]	$85	178%
Nippon Life Ins Co [3695]	$85	178%
Magnacare Commercial [3650]	$88	184%
Blue Cross Blue Shield	$91	190%
Cigna	$93	194%
Mvp Health Plan [2180]	$93	194%
National Association of Letter Carriers [1695]	$93	194%
Emblem Health [2430]	$95	199%
Humana	$95	199%
Amerihealth [3520]	$98	205%

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 $63.
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 Hackensack Meridian Health Pascack Valley Medical 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.