CMS Price Transparency Data

Pneumococcal vaccine

Facility: Good Samaritan Hospital of Suffern

Billing Code: 90732 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90732
Insurance Median: $246
Cash Discount Price: $492
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Pneumococcal vaccine at Good Samaritan Hospital of Suffern is $246. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $492. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

$492

Average discount available for prompt cash payment at this facility.

Insurance Median

$246

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
Hamaspik (McR)	$7	N/A
Medicare (plans)	$7 - $8	N/A
Mvp Gold (McR)	$7	N/A
Affinity By Molina McR	$8	N/A
Beacon Exchange	$9	N/A
Beacon Commercial	$10	N/A
Geisinger Health Commercial/Exchange	$24	N/A
Tricare	$133	N/A
Self-Pay	$148	N/A
Self-Pay - Cc 30%	$148	N/A
Blue Cross Blue Shield	$187 - $246	N/A
Aetna	$221 - $246	N/A
Cdphp	$246	N/A
Mvp Exchange	$246	N/A
Self-Pay - Cc 50%	$246	N/A
Mvp Hmo/Ppo	$246	N/A
Emblem Select Care (Exchange)	$335	N/A
Oxford Commercial	$344	N/A
Cigna	$344	N/A
Magnacare Standard	$344	N/A
UnitedHealthcare	$344	N/A
Oxford Exchange	$344	N/A
Multiplan	$369	N/A
PHCS	$369	N/A
Emblem Ghi/Hip Hmo/Epo/Pos	$394	N/A
Emblem Ghi/Hip PPO	$394	N/A
First Health	$418	N/A
Magnacare Preferred	$443	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 $492.
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 Good Samaritan Hospital of Suffern 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.