CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Margaretville Memorial Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: G0009
  • Insurance Median: $45
  • Cash Discount Price: $68
  • vs. Medicare Baseline: 0.94x Medicare
The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Margaretville Memorial Hospital is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 0.94x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.
Cash / Self-Pay
$68

Average discount available for prompt cash payment at this facility.

Insurance Median
$45

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: $68 (142%)
Insurance Median: $45 (94%)
Cash: $68 (142% of Medicare)
Ins. Median: $45 (94% 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.

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 $10 - $79 21%
UnitedHealthcare $10 - $272 21%
Mvp Gold (McR) $10 - $45 21%
Affinity By Molina McR $10 - $48 21%
Aetna $10 - $67 21%
Medicare (plans) $10 - $68 21%
Hamaspik (McR) $10 - $45 21%
Cdphp $11 - $50 23%
Mvp Exchange $14 - $67 29%
Magnacare Standard $15 - $72 31%
Emblem Select Care (Exchange) $15 - $70 31%
Todays Options $16 - $75 33%
Emblem Ghi/Hip Ppo/Cbp $16 - $74 33%
Self-Pay $17 - $79 36%
Emblem Ghi/Hip Hmo/Epo/Pos $18 - $82 38%
Multiplan $18 - $84 38%
Magnacare Preferred $18 - $82 38%
First Health $20 - $93 42%
Mvp $86 180%
Mvp Hmo/Ppo $102 213%
Oxford $229 - $254 479%
Oxford Exchange $245 512%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 42084 State Highway 28, Margaretville, NY 12455
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals