CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Methodist Hospital Stone Oak

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $130
Cash Discount Price: $396
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Methodist Hospital Stone Oak is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $396. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1139 E Sonterra Blvd,, San Antonio, TX.

Cash / Self-Pay

$396

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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
Superior Health	$14 - $26	N/A
Community First Health Plans	$33 - $62	N/A
Amerigroup	$39 - $72	N/A
Triwest Health Alliance	$40	N/A
Value Options	$40	N/A
United	$65 - $231	N/A
Blue Cross Blue Shield	$82 - $155	N/A
Cigna	$92 - $121	N/A
Superior	$103 - $190	N/A
Aetna	$139 - $257	N/A
National Choicecare	$139 - $257	N/A
Texas Healthcare Foundation Heb	$139 - $257	N/A
Tx Healthcare Foundation	$139 - $257	N/A
Healthsmart Preferred Care	$153 - $283	N/A
Independent Medical Systems	$153 - $283	N/A
Physician Cooperative of Texas	$153 - $283	N/A
Haa Preferred Partners	$167 - $308	N/A
Coastal Comp Health Networks	$181 - $334	N/A
National Healthcare Solutions	$181 - $334	N/A
Tml Intergovernmental Ebp	$195 - $360	N/A
Multiplan	$209 - $437	N/A
Triwest VA Pccc	$209 - $385	N/A
USA Managed Care	$209 - $385	N/A
Blue Bell	$223 - $411	N/A
Directcare America	$223 - $411	N/A
Managed Healthcare	$237 - $437	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 $396.
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 Methodist Hospital Stone Oak 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.