CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Daniels Memorial Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $21
Cash Discount Price: $24
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Daniels Memorial Hospital is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.44x the Medicare baseline. Located in 105 5Th Ave E, Scobey, MT.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

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: $24 (50%)

Insurance Median: $21 (44%)

Cash: $24 (50% of Medicare)

Ins. Median: $21 (44% 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
UnitedHealthcare	$10 - $23	21%
Triwest Ccn-All Plans	$14 - $18	29%
Allegiance McR	$14 - $20	29%
Geha - All Plans	$20	42%
Allegiance Comml-All Other Plans	$20 - $23	42%
Montana Health Co-Op Hpn	$20	42%
Blue Cross Blue Shield	$21	44%
Montana Health Co-Op-All Other Plans	$23	48%
Pacific Source Comml-All Plans	$23	48%
Interwest PPO - All Plans	$23	48%
First Choice Health -All Plans	$47	98%

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 $24.
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 Daniels Memorial Hospital 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.