CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Lovelace Women's Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $206
Cash Discount Price: $69
vs. Medicare Baseline: 4.31x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Lovelace Women's Hospital is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 4.31x the Medicare baseline. Located in 4701 Montgomery Boulevard Ne, Albuquerque, NM.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

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: $69 (144%)

Insurance Median: $206 (431%)

Cash: $69 (144% of Medicare)

Ins. Median: $206 (431% 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 431% of the Medicare baseline (a markup of 331%). 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
The Health Plan [2915]	$46	96%
UnitedHealthcare	$60	125%
Healthscope Benefits [2290]	$60	125%
Corvel Corp [2235]	$92	192%
Enablecomp [1350]	$94	196%
Worker's Comp [2125]	$94	196%
Zelis [2385]	$114	238%
Benefit Management [1175]	$114	238%
Presbyterian Health Plan [1830]	$114	238%
Magellan Behavioral Commercial [2895]	$114	238%
National Telephone Cooperative [1700]	$206	431%
Healthsmart [1505]	$206 - $213	431%
Healthnet [1495]	$206	431%
Kaiser Permanente [1560]	$206	431%
PHCS [1780]	$206	431%
Emblem Health [2430]	$206	431%
Trustmark [2030]	$206	431%
Multiplan [1680]	$206	431%
Fmh Benefit Services [1390]	$206	431%
Coventry Healthcare [1320]	$206	431%
Allied National Global Care [1035]	$206	431%
Mutual of Omaha [1685]	$206	431%
Coresource [1315]	$206	431%
First Health [1375]	$206	431%
Boon-Chapman [2375]	$206	431%
Pan American Life Insurance Co [1770]	$206	431%
Healthcost Solutions [2415]	$206	431%
Administrative Concepts [1005]	$206	431%
Allied Benefit Systems Inc [1030]	$206	431%
Northamerica Administrators [1725]	$206	431%
American Medical Security [2190]	$206	431%
Aetna	$206	431%
Employee Benefit Management Services [2445]	$206	431%

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 $69.
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 Lovelace Women's Hospital 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.