CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Kenmore Mercy Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $22
Cash Discount Price: $82
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Kenmore Mercy Hospital is $22. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.46x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$22

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: $82 (171%)

Insurance Median: $22 (46%)

Cash: $82 (171% of Medicare)

Ins. Median: $22 (46% 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
Blue Cross Blue Shield	$13 - $20	27%
Medicare (plans)	$14 - $51	29%
UnitedHealthcare	$15 - $31	31%
Univera Healthcare Essential [100170]	$17	36%
Mvp Healthcare [100168]	$17	36%
Univera Healthcare [100169]	$17 - $22	36%
UPMC Health Plan [100181]	$17	36%
Humana	$24	50%
VA Veterans Affairs [700001]	$28	59%
Covid19 Hrsa [45013]	$31	65%
Hospice [550001]	$31	65%
Cigna	$31	65%
Fallon Health [450115]	$31	65%
Seneca Nation [450119]	$31	65%
Fidelis Dual Advantage [450120]	$33	69%
Wellcare Fidelis Dual [450451]	$33	69%
Medicaid / KanCare	$35	73%
Wellcare [450129]	$35	73%
Independent Health Essential [100166]	$35 - $42	73%
Independent Health [100165]	$63 - $85	132%
Iha First Choice [800001]	$66	138%

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 $82.
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 Kenmore Mercy 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.