What is Pneumococcal Vaccine 13-valent (CPT 90670)?

Pneumococcal vaccine, 13-valent. This clinical code is utilized across practices and hospitals for diagnostic and therapeutic service documentation.

What do doctors typically charge for Pneumococcal Vaccine 13-valent?

The nationwide median physician charge for Pneumococcal Vaccine 13-valent (CPT 90670) is $334.45. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 90670?

The standard insurance baseline reimbursement rate is $252.83. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Pneumococcal Vaccine 13-valent

CPT 90670Medical Service

Pneumococcal Vaccine 13-valent

Pneumococcal vaccine, 13-valent. Clinical pricing breakdown and utilization metrics across 626 practicing doctors nationwide.

$334.45

Peer Median Charge

Gross billed rate

$252.83

Standard Baseline

Customary allowable

1.3x

National Markup

Charge vs baseline

626

Active Physicians

Billing this code

Planning care or already received a bill for CPT 90670?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $334.45. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $252.83 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 90670 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"