CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Mercyone Oelwein Medical Center

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $127
Cash Discount Price: $116
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Mercyone Oelwein Medical Center is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 201 Eighth Avenue Se, Oelwein, IA.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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
Bcn Domestic	$40	N/A
Blue Care Network	$40	N/A
Kaiser Domestic	$40	N/A
Blue Shield - Id (Regence)	$40	N/A
Blue Shield - Wa (Regence)	$40	N/A
Blue Shield - Ny Highmark Northeastern	$40	N/A
Pre-Employment	$40	N/A
Wc Domestic	$40	N/A
Blue Shield - Ca	$40	N/A
Blue Cross Blue Shield	$40 - $72	N/A
Blue Shield - Ny Highmark Western	$40	N/A
Blue Distinction Transplant	$40	N/A
Blue Benefit Administrators of Massachusetts	$40	N/A
Blue Shield - PA (Highmark)	$40	N/A
Medicare (plans)	$68 - $76	N/A
Iowa Total Care	$69	N/A
Medicaid / KanCare	$70	N/A
UnitedHealthcare	$77 - $154	N/A
Aetna	$84 - $164	N/A
Amish Hospital Aid	$97	N/A
Centivo	$109	N/A
Ambetter / Centene	$123	N/A
Medical Associates	$131	N/A
Health Choices	$131	N/A
Claimdoc	$147	N/A
Nova	$147	N/A
Geha	$154	N/A
Medical Mutual	$164	N/A
1199 National Benefit Fund	$164	N/A
Coventry	$164	N/A
Webtpa	$164	N/A
Trustmark Small Business Benefits	$164	N/A
Asr Health Benefits	$164	N/A
Meritain	$164	N/A
Luminare Health	$164	N/A
Lucent Health	$164	N/A
Christian Brother Services	$164	N/A
First Health	$164	N/A
Allied Benefit Systems	$164	N/A
Health Partners	$171	N/A
Multiplan	$173	N/A
Auxiant	$174	N/A
Midlands	$174	N/A
Midlands Choice	$174	N/A
Medica	$174	N/A
Cigna	$174	N/A
Crime Victim Assistance	$178	N/A
Iowa Dept of Public Health	$178	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 $116.
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 Mercyone Oelwein Medical Center 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.