CMS Price Transparency Data

Pneumococcal vaccine

Facility: Sisters of Charity Hospital

Billing Code: 90732 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90732
Insurance Median: $133
Cash Discount Price: $303
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Pneumococcal vaccine at Sisters of Charity Hospital is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $303. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$303

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
No Fault [114001]	$21	N/A
Workers Compensation [500101]	$21	N/A
Federal Workers Compensation [500100]	$21	N/A
UnitedHealthcare	$117 - $140	N/A
Blue Cross Blue Shield	$117 - $253	N/A
Independent Health [100165]	$119 - $129	N/A
Medicaid / KanCare	$119 - $133	N/A
Iha First Choice [800001]	$119 - $129	N/A
Independent Health Essential [100166]	$119 - $129	N/A
Medicare (plans)	$119 - $133	N/A
Univera Healthcare [100169]	$123	N/A
Univera Healthcare Essential [100170]	$123 - $148	N/A
Wellcare [450129]	$125 - $147	N/A
Molina Essential [100167]	$133	N/A
Seneca Nation [450119]	$133	N/A
Fallon Health [450115]	$133	N/A
Covid19 Hrsa [45013]	$133	N/A
Humana	$133	N/A
Cigna	$133	N/A
Hospice [550001]	$133	N/A
VA Veterans Affairs [700001]	$133	N/A
Ghi [100153]	$147	N/A
UPMC Health Plan [100181]	$155	N/A

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 $303.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90732.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sisters of Charity Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90732.
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.