CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $49
Cash Discount Price: $23
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Mary Hitchcock Memorial Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$23

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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
Amerihealth Caritas Nh	$8	N/A
Wellsense Health Plan	$9 - $42	N/A
Beacon Health Strategies/Carelon	$9	N/A
Granite State Health Plan	$9	N/A
Harvard Pilgrim Health Care of Ne	$24 - $100	N/A
Martin's Point Health Care	$26 - $39	N/A
Aetna	$33 - $56	N/A
UnitedHealthcare	$37 - $67	N/A
Mvp	$40 - $50	N/A
Blue Cross Blue Shield	$40 - $199	N/A
Martin's Point Generations Advantage	$40	N/A
Cigna	$41 - $105	N/A
Wellcare Health Plans	$41	N/A
Tufts Health Plan	$42 - $49	N/A
Ambetter / Centene	$42 - $131	N/A
Mass General Brigham Health Plan	$43 - $82	N/A
Maine Community Health Options	$47 - $55	N/A
First Health/Hcvm	$65	N/A
Coventry	$65	N/A
PHCS	$67	N/A
Corvel	$68	N/A
Ccmsi	$71	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 $23.
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 Mary Hitchcock 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.