CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Frisbie Memorial Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $151
Cash Discount Price: $529
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Frisbie Memorial Hospital is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $529. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 11 Whitehall Road, Rochester, NH.

Cash / Self-Pay

$529

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

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
Humana	$38	N/A
Martin's Point Health	$39	N/A
Amerihealth Caritas	$44	N/A
Blue Cross Blue Shield	$50 - $62	N/A
Well Sense Health Plan	$65	N/A
Harvard Pilgrim	$140 - $214	N/A
Cigna	$145	N/A
Maine Community Health	$151 - $256	N/A
Tufts Health Plan	$181 - $303	N/A
United	$181 - $319	N/A
Aetna	$306	N/A
Evernorth	$423	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 $529.
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 Frisbie 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.