CMS Price Transparency Data

Pneumonia vaccine injection

Facility: St Luke's Patients Medical Center

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $74
Cash Discount Price: $45
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at St Luke's Patients Medical Center is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.55x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $45 (94%)

Insurance Median: $74 (155%)

Cash: $45 (94% of Medicare)

Ins. Median: $74 (155% 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
United	$37 - $62	77%
Blue Cross Blue Shield	$46 - $129	96%
Cigna	$46 - $100	96%
Humana	$46	96%
Kelsey	$46	96%
Aetna	$47	98%
Amerivantage	$48	100%
Devoted	$49	102%
Scanhealth	$49	102%
Bright Health	$67	140%
Ambetter / Centene	$69	144%
Community Health Choice	$69	144%
Wellpoint	$69	144%
Coventry	$84	176%
First Health	$84	176%
Healthsmart	$90	188%
Multiplan	$97	203%

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 $45.
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 St Luke's Patients 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.