CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Licking Memorial Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $202
Cash Discount Price: $237
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Licking Memorial Hospital is $202. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $237. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1320 West Main Street, Newark, OH.

Cash / Self-Pay

$237

Average discount available for prompt cash payment at this facility.

Insurance Median

$202

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
Medical Mutual [100114]	$124 - $207	N/A
Blue Cross Blue Shield	$133	N/A
Medben [700068]	$157 - $245	N/A
Benicomp [70090]	$168 - $187	N/A
Consociate Health [100029]	$180 - $200	N/A
Consociate Health 6 Degrees [100059]	$180 - $200	N/A
Optima [700069]	$184 - $204	N/A
Aetna	$184 - $206	N/A
Meritain [100063]	$184 - $204	N/A
Geha [100039]	$184 - $204	N/A
Allied Benefit Systems [100015]	$184 - $204	N/A
Gravie Administrative Services [100165]	$184 - $204	N/A
Trustmark Small Business Benefits [100263]	$184 - $204	N/A
Webtpa [100127]	$184 - $204	N/A
Healthscope [100157]	$191 - $212	N/A
United Medical Resources [700071]	$191 - $212	N/A
Surest [100016]	$191 - $212	N/A
UnitedHealthcare	$191 - $212	N/A
Cigna	$202 - $225	N/A
The Health Plan [100261]	$202 - $225	N/A
Ohio Healthy Luminare Health [100264]	$202 - $225	N/A
Great West Life [700064]	$202 - $225	N/A
Ohio Healthy [100255]	$202 - $225	N/A
Wellfleet Group, LLC [100164]	$202 - $225	N/A
Antidote Health Plan of Ohio [70006803]	$202 - $225	N/A
American Postal Workers [100089]	$202 - $225	N/A
Ohio PPO Connect [70006801]	$202 - $225	N/A
Osu Prime Care [100254]	$202 - $225	N/A
Quality Care Partners [70006802]	$202 - $225	N/A
National Association of Letter Carriers [100067]	$202 - $225	N/A
Coresource [100002]	$202 - $250	N/A
Coventry [100010]	$207 - $231	N/A
Pan American Life [700070]	$207 - $231	N/A
Ohio Health Choice [100109]	$216 - $240	N/A
Philadelphia American Life [100260]	$218 - $250	N/A
Humana	$218 - $242	N/A
Reliance Standard-Asrm [100258]	$218 - $242	N/A
Carefactor [100087]	$218 - $242	N/A
Administrative Concepts [100006]	$218 - $242	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 $237.
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 Licking 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.