CMS Price Transparency Data

DTaP vaccine (diphtheria, tetanus, pertussis)

Facility: Sisters of Charity Hospital

Billing Code: 90700 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90700
Insurance Median: $30
Cash Discount Price: $53
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a DTaP vaccine (diphtheria, tetanus, pertussis) at Sisters of Charity Hospital is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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
Workers Compensation [500101]	$26	N/A
Federal Workers Compensation [500100]	$26	N/A
No Fault [114001]	$26	N/A
Independent Health Essential [100166]	$29 - $32	N/A
VA Veterans Affairs [700001]	$29	N/A
UnitedHealthcare	$29 - $39	N/A
Medicare (plans)	$29 - $32	N/A
Independent Health [100165]	$29 - $32	N/A
Medicaid / KanCare	$29 - $32	N/A
Iha First Choice [800001]	$29 - $32	N/A
Univera Healthcare Essential [100170]	$30 - $36	N/A
UPMC Health Plan [100181]	$30	N/A
Univera Healthcare [100169]	$30	N/A
Humana	$32	N/A
Blue Cross Blue Shield	$33 - $38	N/A
Ghi [100153]	$36	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 $53.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90700.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sisters of Charity Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90700.
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.