CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: St Luke's Hospital at the Vintage

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $119
Cash Discount Price: $71
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at St Luke's Hospital at the Vintage is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 20171 Chasewood Park Drive, Houston, TX.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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
Aetna	$40 - $74	N/A
Blue Cross Blue Shield	$43 - $128	N/A
United	$47 - $108	N/A
UnitedHealthcare	$49 - $191	N/A
Bright Health	$60 - $76	N/A
Tchpchip	$63 - $99	N/A
Cigna	$65 - $165	N/A
Humana	$87 - $150	N/A
Kelseycare	$89 - $113	N/A
Chc	$100 - $127	N/A
Texastruechoice	$100 - $127	N/A
Independent Med System	$109 - $138	N/A
Coventry	$118 - $150	N/A
First Health	$118 - $150	N/A
Healthsmart	$127 - $166	N/A
Interlink	$127 - $162	N/A
PHCS	$127 - $162	N/A
PHCS Savility	$127 - $162	N/A
Multiplan	$136 - $173	N/A
USA Health Network	$154 - $196	N/A
Mhealth Network	$181 - $231	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 $71.
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 St Luke's Hospital at the Vintage 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.