CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Jones Memorial Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $31
Cash Discount Price: $43
vs. Medicare Baseline: 0.65x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Jones Memorial Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.65x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $43 (90%)

Insurance Median: $31 (65%)

Cash: $43 (90% of Medicare)

Ins. Median: $31 (65% 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
Medicaid / KanCare	$13 - $31	27%
Blue Cross Blue Shield	$15 - $122	31%
UnitedHealthcare	$15 - $63	31%
Medicare (plans)	$16 - $69	33%
Excellus 2201	$26 - $31	54%
Aetna	$31 - $66	65%
UPMC Health Plan 5138	$47	98%
Total Senior Care 1319	$63	132%
Humana	$63	132%
Empire Plan 5179	$111	232%
Mvp 2900	$148	309%
Cigna	$153	320%

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 $43.
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 Jones Memorial 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.