CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Intermountain Health Sanpete Valley Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $148
Cash Discount Price: $117
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Intermountain Health Sanpete Valley Hospital is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1100 South Medical Drive, Mount Pleasant, UT.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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
American Health	$37 - $47	N/A
Blue Cross Blue Shield	$37 - $148	N/A
Health Partners of Nevada	$37 - $47	N/A
Molina	$37 - $148	N/A
UnitedHealthcare	$37 - $148	N/A
Health Plan of Nevada	$37 - $139	N/A
Selecthealth	$37 - $148	N/A
Healthy U	$37 - $139	N/A
Aetna	$37 - $150	N/A
Humana	$37 - $148	N/A
Triwest	$49 - $141	N/A
Injury Care of Nevada	$117	N/A
Wcf Insurance	$133	N/A
Corporation of the President	$133	N/A
Byu Risk Management	$133	N/A
Corvel Corporation	$133	N/A
Cigna	$148	N/A
Utah Tech	$148	N/A
Lw Miller	$148	N/A
Pehp	$148	N/A
Springtide	$148	N/A
Awh Connected	$148 - $150	N/A
Emi	$148	N/A
Wise Network	$148	N/A
Emi Health	$148	N/A
Uofu	$148	N/A
Motivhealth	$148	N/A
Health Utah	$148	N/A
Tanner LLC	$148	N/A
Hygeia Corporation	$148	N/A
Juniper Systems	$148	N/A
Franklin County	$148	N/A
Prodegi Corp Benefit	$148	N/A
Global Excel	$148	N/A
Deseret Mutual	$148	N/A
Byu Athletics	$148	N/A
Medcare International	$148	N/A
Ifit	$148	N/A
Campbell Scientific	$148	N/A
Managed Care Admin	$148	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 $117.
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 Intermountain Health Sanpete Valley 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.