CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $61
Cash Discount Price: $40
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Carilion Stonewall Jackson Hospital is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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
Humana	$36 - $43	N/A
Aetna	$37 - $76	N/A
Blue Cross Blue Shield	$41	N/A
UnitedHealthcare	$41 - $93	N/A
Sentara Health Plan	$42 - $71	N/A
Abh of VA (Formerly Coventry)	$43	N/A
Abh of Wva (Formerly Coventry)	$43	N/A
Gateway - Tier 3	$63	N/A
Vhn - Ultra	$71	N/A
Connecticare	$80	N/A
Cigna	$91	N/A
Gateway - Tier 2	$91	N/A
Vhn - Plus	$91	N/A
Integrated Health Plan	$97	N/A
Vhn	$97	N/A
Vhn - Link	$102	N/A
Beech Street	$105	N/A
Gateway - Tier 1	$108	N/A
Vhn - Secondary Payors	$108	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 $40.
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 Carilion Stonewall Jackson 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.