CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Lewisgale Hospital Pulaski

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $193
Cash Discount Price: $262
vs. Medicare Baseline: 4.03x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Lewisgale Hospital Pulaski is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $262. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 4.03x the Medicare baseline. Located in 2400 Lee Highway, Pulaski, VA.

Cash / Self-Pay

$262

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $262 (548%)

Insurance Median: $193 (403%)

Cash: $262 (548% of Medicare)

Ins. Median: $193 (403% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 403% of the Medicare baseline (a markup of 303%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Lifeworks	$47 - $52	98%
Universal Healthcare Group	$54 - $61	113%
United	$82 - $124	171%
Virginia Health Network	$86 - $196	180%
Aetna	$89 - $124	186%
Cigna	$102 - $115	213%
Greenvbrier Sporting Club	$148 - $166	309%
Corvel	$178 - $199	372%
Richfield Retirement Community	$185 - $207	387%
Richfield Nursing Center	$185 - $207	387%
Multiplan	$190 - $213	397%
Community Care Network	$198 - $221	414%
One Health Plan	$198 - $221	414%
Graham-White Manufacturing	$198 - $221	414%
Occunet Workers Comp	$198 - $221	414%
Patients Choice	$217 - $243	454%
PHCS	$222 - $248	464%
4Most	$222 - $248	464%
Star Transportation	$222 - $248	464%
American Postal Workers Union	$222 - $248	464%

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 $262.
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 Hospital Pulaski 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.