CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Portneuf Medical Center

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $287
Cash Discount Price: $203
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Portneuf Medical Center is $287. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $203. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$203

Average discount available for prompt cash payment at this facility.

Insurance Median

$287

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 (%)

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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	$70 - $287	N/A
UnitedHealthcare	$70 - $305	N/A
Healthscope Benefits [2290]	$70	N/A
Pacific Source Health Plans [2850]	$102	N/A
Web Tpa [2115]	$139	N/A
Pending Ssi [1616]	$139	N/A
Lucent Health [6000]	$139	N/A
Employee Benefit Management Services [2445]	$139 - $203	N/A
Black Lung [6055]	$139	N/A
Moda Health [6100]	$139	N/A
Oncology Patient Assistance Programs [2295]	$139	N/A
Healthcare Highways [2210]	$139 - $322	N/A
Medishare Christian Care [1645]	$203	N/A
Liberty Health Share Lhs/Medcost Solutions LLC [2400]	$203	N/A
Multiplan [1680]	$227 - $322	N/A
Cigna	$249	N/A
First Health [1375]	$279	N/A
Mailhandlers [1595]	$287	N/A
Selecthealth [3740]	$287 - $305	N/A
Humana	$305	N/A
Geha [1415]	$305	N/A
Healthfirst [2395]	$322	N/A
Mayo Clinic Health Solutions [2280]	$322	N/A
Pba [1775]	$322	N/A
Meritain Health [1655]	$322	N/A
New Era Life Insurance Company [1705]	$322	N/A
National Association of Letter Carriers [1695]	$322	N/A
Healthnet [1495]	$322	N/A
Pan American Life Insurance Co [1770]	$322	N/A
Trustmark [2030]	$322	N/A
UT Id Teamsters [3760]	$322	N/A
Hometown Health [2155]	$322	N/A
Mutual of Omaha [1685]	$322	N/A
Planned Administrators Inc [2360]	$322	N/A
PHCS [1780]	$322	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 $203.
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 Portneuf Medical Center 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.