CMS Price Transparency Data

Pneumococcal vaccine

Facility: Holy Cross Hospital-Davis

Billing Code: 90732 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90732
Insurance Median: $368
Cash Discount Price: $281
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Pneumococcal vaccine at Holy Cross Hospital-Davis is $368. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1600 West Antelope Drive, Layton, UT.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$368

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
Blue Cross Blue Shield	$115 - $421	N/A
Humana	$131	N/A
Medicare (plans)	$131	N/A
Uuhp	$133 - $381	N/A
Medicaid / KanCare	$133	N/A
Employer Direct Healthcare	$164	N/A
Motivhealth	$174	N/A
Centura Employee Plan	$246	N/A
Cigna	$251 - $562	N/A
Molina	$278 - $302	N/A
Pehp	$300 - $407	N/A
Aetna	$310 - $594	N/A
Select Health	$345	N/A
Wise	$365 - $372	N/A
UnitedHealthcare	$406 - $702	N/A
Multiplan	$414 - $639	N/A
Deseret Mutual Benefit Administrators	$431	N/A
Emi Health	$611	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 $281.
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 Holy Cross Hospital-Davis 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.