CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Baylor Scott and White Medical Center McKinney

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $46
Cash Discount Price: $43
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Baylor Scott and White Medical Center McKinney is $46. 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 0.96x the Medicare baseline. Located in 5252 West University Drive, Mc Kinney, TX.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $46 (96%)

Cash: $43 (90% of Medicare)

Ins. Median: $46 (96% 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
Superior Health Plan	$10 - $46	21%
Baylor Scott & White Health Plan	$35 - $72	73%
Cigna	$35 - $41	73%
Aetna	$39 - $43	82%
Employers Health Network	$39	82%
Quiktrip	$39	82%
University of Mary Hardin-Baylor	$41	86%
Humana	$43 - $50	90%
Triwest	$43	90%
Imagine Health	$44	92%
UnitedHealthcare	$44 - $50	92%
American Health Plan	$46	96%
Blue Cross Blue Shield	$46 - $294	96%
Corvel	$46	96%
Curative	$46	96%
Healthspring	$46	96%
Prime Health Services	$46	96%
Procare Advantage	$46	96%
First Health	$50	105%
Healthsmart	$50 - $53	105%
Private Health Care System	$53	111%
Ambetter / Centene	$90	188%

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 Baylor Scott and White Medical Center McKinney 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.