CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Lewisgale Medical Center

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $67
Cash Discount Price: $96
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Lewisgale Medical Center is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.40x the Medicare baseline. Located in 1900 Electric Road, Salem, VA.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $96 (201%)

Insurance Median: $67 (140%)

Cash: $96 (201% of Medicare)

Ins. Median: $67 (140% 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	$15 - $48	31%
Lifeworks	$16 - $21	33%
Universal Healthcare Group	$18 - $24	38%
Virginia Health Network	$29 - $77	61%
Aetna	$30 - $58	63%
United	$31 - $49	65%
Greenbrier Sporting Club	$31 - $40	65%
Naphcare	$42 - $54	88%
Greenvbrier Sporting Club	$50 - $65	105%
Richfield Nursing Center	$59 - $76	123%
Graham-White Manufacturing	$59 - $76	123%
Corvel	$60 - $78	125%
Richfield Retirement Community	$63 - $82	132%
Community Care Network	$63 - $82	132%
One Health Plan	$67 - $87	140%
Csx Hotels	$67 - $87	140%
Occunet Workers Comp	$67 - $87	140%
Patients Choice	$74 - $96	155%
American Postal Workers Union	$76 - $98	159%
C&O Employees Hospital Assn	$76 - $98	159%
PHCS	$76 - $98	159%
Alleghany Highland Community	$76 - $98	159%
4Most	$76 - $98	159%
Star Transportation	$76 - $98	159%
Multiplan	$76 - $98	159%

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 $96.
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 Lewisgale 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.