CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Roundup Memorial Healthcare

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $25
Cash Discount Price: $27
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Roundup Memorial Healthcare is $25. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1202 3Rd St W, Roundup, MT.

Cash / Self-Pay

$27

Average discount available for prompt cash payment at this facility.

Insurance Median

$25

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
UnitedHealthcare	$4 - $53	N/A
Tricare	$4 - $53	N/A
VA Ccn - All Plans	$4 - $53	N/A
Geha-All Plans	$7 - $88	N/A
Blue Cross Blue Shield	$8 - $108	N/A
Pacific Source-All Plans	$9 - $102	N/A
First Choice-All Plans	$9 - $104	N/A
Ebms (Rmhn Network) - All Plans	$9 - $102	N/A
Montana Health Co-Op Ppo/Pos - All Plans	$9 - $104	N/A
Multiplan-All Plans	$9 - $104	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 $27.
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 Roundup Memorial Healthcare 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.