CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Memorial Hospital of Carbon County

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $216
Cash Discount Price: $187
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Memorial Hospital of Carbon County is $216. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $187. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2221 West Elm Street, Rawlins, WY.

Cash / Self-Pay

$187

Average discount available for prompt cash payment at this facility.

Insurance Median

$216

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
Lhi	$49	N/A
Blue Cross Blue Shield	$125 - $237	N/A
Medicare (plans)	$125 - $134	N/A
Vaccn	$125 - $134	N/A
Three_River_Providers_Network	$180 - $193	N/A
Wise_Provider_Networks	$180 - $193	N/A
Zelis	$180 - $193	N/A
Corechoice	$216 - $232	N/A
First_Choice_Health	$216 - $232	N/A
Cigna	$223 - $240	N/A
UnitedHealthcare	$230 - $248	N/A
Interwests_Ppo_Network	$233 - $250	N/A
Multiplan	$233 - $250	N/A
Medicaid / KanCare	$240 - $258	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 $187.
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 Memorial Hospital of Carbon County 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.