CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Johnson Memorial Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $196
Cash Discount Price: $236
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Johnson Memorial Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $236. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 201 Chestnut Hill Road, Stafford Springs, CT.

Cash / Self-Pay

$236

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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 (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

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

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Connecticare	$19 - $32	N/A
Health Partners	$62	N/A
Allegiance	$62	N/A
Magnacare	$62	N/A
Cigna	$62 - $184	N/A
Aetna	$147 - $184	N/A
Health New England	$153	N/A
Blue Cross Blue Shield	$183 - $236	N/A
1199 National Benefit Fund	$184	N/A
Meritain	$184	N/A
Hap	$184	N/A
Luminare Health	$184	N/A
Allied Benefit Systems	$184	N/A
Gravie Admin Services	$184	N/A
Nippon Life Ins	$184	N/A
Webtpa	$184	N/A
Prime Health Services	$189	N/A
Harvard Pilgrim Healthcare	$189	N/A
UnitedHealthcare	$189 - $236	N/A
Geha	$189	N/A
Lifetime Benefit Solutions	$196	N/A
Pai	$196	N/A
Manhattan Life	$196	N/A
Medi Share	$196	N/A
PHCS	$196	N/A
Trinity Health Share	$196	N/A
Paramount HMO	$196	N/A
Mvp	$196	N/A
Allied National Global Care	$196	N/A
Family Life Insurance Company	$196	N/A
Dean Health	$196	N/A
Pan-American Life	$196	N/A
Christian Care Ministry	$196	N/A
Multiplan	$196	N/A
Asrm - Reliance Standard Life Insurance	$196	N/A
International Benefit Administrators	$196	N/A
Ghc Scw	$196	N/A
Health Smart	$200	N/A
Blue Shield - Wa (Regence)	$236	N/A
Blue Shield - Id (Regence)	$236	N/A
Wc Domestic	$236	N/A
Unicare	$236	N/A
Blue Shield - PA (Highmark)	$236	N/A
United Behavioral Health Eap	$236	N/A
Wellpoint	$236	N/A
Blue Shield - Ny Highmark Western	$236	N/A
Blue Benefit Administrators of Massachusetts	$236	N/A
Blue Shield - Ny Highmark Northeastern	$236	N/A
Blue Shield - Ca	$236	N/A
Pre-Employment	$236	N/A
Blue Distinction Transplant	$236	N/A
Blue Care Network	$236	N/A
Bcn Domestic	$236	N/A
Health Choices	$236	N/A
Kaiser Domestic	$236	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 $236.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90715.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Johnson Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90715.
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.