CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Holy Cross Hospital-Jordan Valley

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $71
Cash Discount Price: $54
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Holy Cross Hospital-Jordan Valley is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.48x the Medicare baseline. Located in 3580 West 9000 South, West Jordan, UT.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $54 (113%)

Insurance Median: $71 (148%)

Cash: $54 (113% of Medicare)

Ins. Median: $71 (148% 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
Medicare (plans)	$47	98%
Humana	$47	98%
Aetna	$48 - $114	100%
Rocky Mountain Health Plan	$48	100%
Health Choice	$48	100%
Colorado Access	$48	100%
Cigna	$48 - $108	100%
Denver Health	$48	100%
Molina	$48 - $100	100%
Uuhp	$48 - $73	100%
Blue Cross Blue Shield	$50 - $84	105%
Pehp	$58 - $135	121%
Employer Direct Healthcare	$59	123%
Motivhealth	$62	130%
Centura Employee Plan	$68	142%
Wise	$70 - $72	146%
Deseret Mutual Benefit Administrators	$83	173%
Select Health	$90	188%
Multiplan	$93 - $123	194%
Emi Health	$135	282%
UnitedHealthcare	$135	282%

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 $54.
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 Holy Cross Hospital-Jordan Valley 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.