CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Childrens Hospital of Wisconsin Fox Valley

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $14
Cash Discount Price: $8
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Childrens Hospital of Wisconsin Fox Valley is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 130 Second St, Neenah, WI.

Cash / Self-Pay

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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
Blue Cross Blue Shield	$10 - $65	N/A
Froedtert Health	$10 - $143	N/A
Medical College of Wisconsin	$10 - $111	N/A
Aspirus Health Plan	$11 - $114	N/A
Common Ground Healthcare Cooperative	$11 - $114	N/A
Network Health Plan	$11 - $109	N/A
Trilogy Health Solutions	$11 - $127	N/A
UnitedHealthcare	$11 - $85	N/A
Wps Health Plan	$11 - $111	N/A
Advocate Aurora Healthcare	$12 - $119	N/A
Centivo	$12 - $116	N/A
Dean Health Plan	$12 - $127	N/A
Employer Health Care Alliance Cooperative	$12 - $78	N/A
Group Health Cooperative of Eau Claire	$12	N/A
Health Partners	$12 - $140	N/A
Oan LLC	$12 - $127	N/A
Security Health Plan	$12 - $132	N/A
Aetna	$13 - $143	N/A
America's PPO	$13 - $138	N/A
Health Payment Systems	$13 - $135	N/A
Praire States	$13	N/A
Quartz Health Insurance	$13	N/A
Sheboygan Employer's Health Network	$13 - $135	N/A
Bellin Thedacare	$14	N/A
Cigna	$14 - $143	N/A
Coventry Health Care	$14 - $151	N/A
Group Health Cooperative of South Central Wisconsin	$14 - $143	N/A
Healthsmart	$14	N/A
Multiplan	$14 - $145	N/A
Prevea Health Network	$14	N/A
Chorus Community Health Plan	$16	N/A
Icare	$16	N/A
Managed Health Services	$16	N/A
Molina Healthcare of Wisconsin	$16	N/A
My Choice Wisconsin	$16	N/A
Quartz Health Solutions	$135	N/A
Healthsmart Payers Organization	$143	N/A
Health Payers Organization	$151	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 $8.
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 Childrens Hospital of Wisconsin Fox Valley 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.