CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Mount Sinai Rehabilitation Hospital Inc

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $94
Cash Discount Price: $140
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Mount Sinai Rehabilitation Hospital Inc is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 490 Blue Hills Ave, Hartford, CT.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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
Blue Cross Blue Shield	$34 - $43	N/A
Unicare	$43	N/A
Wc Domestic	$43	N/A
Blue Shield - Ny Highmark Northeastern	$43	N/A
Blue Distinction Transplant	$43	N/A
Blue Shield - Wa (Regence)	$43	N/A
Health Choices	$43	N/A
Blue Shield - Ca	$43	N/A
Kaiser Domestic	$43	N/A
Bcn Domestic	$43	N/A
Blue Benefit Administrators of Massachusetts	$43	N/A
Blue Shield - Ny Highmark Western	$43	N/A
Blue Shield - PA (Highmark)	$43	N/A
Pre-Employment	$43	N/A
Blue Care Network	$43	N/A
Blue Shield - Id (Regence)	$43	N/A
Magnacare	$62	N/A
Connecticare	$62 - $68	N/A
Cigna	$62	N/A
Health Partners	$62	N/A
Allegiance	$62	N/A
UnitedHealthcare	$69 - $71	N/A
Harvard Pilgrim Healthcare	$69 - $71	N/A
Geha	$69 - $71	N/A
Health New England	$74 - $75	N/A
Aetna	$90 - $115	N/A
Lifetime Benefit Solutions	$94 - $96	N/A
Pan-American Life	$94 - $96	N/A
Ghc Scw	$94 - $96	N/A
International Benefit Administrators	$94 - $96	N/A
Manhattan Life	$94 - $96	N/A
Multiplan	$94 - $96	N/A
Allied National Global Care	$94 - $96	N/A
Family Life Insurance Company	$94 - $96	N/A
PHCS	$94 - $96	N/A
Asrm - Reliance Standard Life Insurance	$94 - $96	N/A
Trinity Health Share	$94 - $96	N/A
Medi Share	$94 - $96	N/A
Christian Care Ministry	$94 - $96	N/A
Pai	$94 - $96	N/A
Paramount HMO	$94 - $96	N/A
Dean Health	$94 - $96	N/A
Mvp	$94 - $96	N/A
Prime Health Services	$111 - $113	N/A
Nippon Life Ins	$113 - $115	N/A
Webtpa	$113 - $115	N/A
Meritain	$113 - $115	N/A
Hap	$113 - $115	N/A
Allied Benefit Systems	$113 - $115	N/A
Gravie Admin Services	$113 - $115	N/A
Luminare Health	$113 - $115	N/A
1199 National Benefit Fund	$113 - $115	N/A
Health Smart	$118 - $120	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 $140.
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 Mount Sinai Rehabilitation Hospital Inc 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.