CMS Price Transparency Data

Pneumococcal vaccine

Facility: Licking Memorial Hospital

Billing Code: 90732 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90732
Insurance Median: $265
Cash Discount Price: $312
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Pneumococcal vaccine at Licking Memorial Hospital is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $312. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1320 West Main Street, Newark, OH.

Cash / Self-Pay

$312

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

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
Aetna	$109 - $257	N/A
Medical Mutual [100114]	$171 - $259	N/A
Medben [700068]	$218 - $305	N/A
Benicomp [70090]	$234	N/A
Consociate Health 6 Degrees [100059]	$249	N/A
Consociate Health [100029]	$249	N/A
Optima [700069]	$255	N/A
Webtpa [100127]	$255	N/A
Gravie Administrative Services [100165]	$255	N/A
Geha [100039]	$255	N/A
Allied Benefit Systems [100015]	$255	N/A
Trustmark Small Business Benefits [100263]	$255	N/A
Meritain [100063]	$255	N/A
UnitedHealthcare	$265	N/A
United Medical Resources [700071]	$265	N/A
Healthscope [100157]	$265	N/A
Surest [100016]	$265	N/A
American Postal Workers [100089]	$280	N/A
Ohio PPO Connect [70006801]	$280	N/A
Quality Care Partners [70006802]	$280	N/A
The Health Plan [100261]	$280	N/A
Coresource [100002]	$280 - $312	N/A
National Association of Letter Carriers [100067]	$280	N/A
Ohio Healthy [100255]	$280	N/A
Wellfleet Group, LLC [100164]	$280	N/A
Antidote Health Plan of Ohio [70006803]	$280	N/A
Cigna	$280	N/A
Ohio Healthy Luminare Health [100264]	$280	N/A
Great West Life [700064]	$280	N/A
Osu Prime Care [100254]	$280	N/A
Coventry [100010]	$288	N/A
Pan American Life [700070]	$288	N/A
Ohio Health Choice [100109]	$299	N/A
Administrative Concepts [100006]	$302	N/A
Carefactor [100087]	$302	N/A
Humana	$302	N/A
Reliance Standard-Asrm [100258]	$302	N/A
Philadelphia American Life [100260]	$302 - $312	N/A
Blue Cross Blue Shield	$447	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 $312.
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 Licking Memorial 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.