CMS Price Transparency Data

Flu vaccine injection

Facility: Falls Community Hospital and Clinic

Billing Code: G0008 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0008
Insurance Median: $42
Cash Discount Price: $72
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Flu vaccine injection at Falls Community Hospital and Clinic is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.88x the Medicare baseline. Located in 322 Coleman Street, Marlin, TX.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $72 (151%)

Insurance Median: $42 (88%)

Cash: $72 (151% of Medicare)

Ins. Median: $42 (88% 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
Cigna	$18	38%
Humana	$42	88%
Scott and White	$42	88%
UnitedHealthcare	$42 - $63	88%
Aetna	$72	151%
Blue Cross Blue Shield	$107	224%

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 $72.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0008.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Falls Community Hospital and Clinic is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0008.
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.