CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Mercy St Francis Hospital

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $199
Cash Discount Price: $143
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Mercy St Francis Hospital is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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
Medicaid / KanCare	$40 - $118	N/A
UnitedHealthcare	$43 - $211	N/A
Indian Health Service Contracted [320198]	$61 - $75	N/A
Dept of Veteran Affairs Contracted [320106]	$61 - $75	N/A
Globalhealth Contracted [320145]	$61 - $75	N/A
Kindful Hospice Contracted [320434]	$61 - $75	N/A
Acentra Health Contracted [320527]	$61 - $62	N/A
Medical Associates Health Contracted [320444]	$61 - $75	N/A
Blue Cross Blue Shield	$61 - $220	N/A
Mercy Hospice Okc [20252]	$61 - $75	N/A
Elara Caring Aspire Hospice [20433]	$61 - $75	N/A
Cigna	$61 - $216	N/A
Kindful Hospice [20434]	$61 - $75	N/A
Cherokee Nation Health Serv Contracted [320066]	$61 - $75	N/A
Humana	$61 - $204	N/A
Medicare (plans)	$61 - $78	N/A
Provider Partners Health Plans Contracted [320450]	$61 - $75	N/A
Halo Hcr Inc Hospice [20432]	$61 - $75	N/A
Cross Timbers Hospice [20098]	$61 - $75	N/A
Pace of the Ozarks Contracted [320518]	$61 - $75	N/A
Mercy Mgd Behavioral Health Contracted [320259]	$61 - $75	N/A
Aetna	$61 - $202	N/A
Halo Hcr Inc Hospice Contracted [320432]	$61 - $75	N/A
Qual Choice Contracted [320325]	$61 - $75	N/A
Tricare	$74 - $77	N/A
Healthscope Contracted [320182]	$76 - $100	N/A
Administrative Payor Contracted [320005]	$97 - $102	N/A
Centivo Contracted [320505]	$101 - $127	N/A
Novasys Contracted [320285]	$112 - $118	N/A
Home State Health Plan Contracted [320187]	$112 - $118	N/A
Ambetter / Centene	$112 - $118	N/A
Preferred Health Plan Contracted [320522]	$141 - $148	N/A
Healthlink Contracted [320179]	$141 - $216	N/A
Workers Comp [20426]	$173 - $193	N/A
Auxiant Contracted [320462]	$195 - $216	N/A
Mercy Benefit Admin Contracted [320251]	$195 - $216	N/A
United Medical Resources Contracted [320454]	$195 - $211	N/A
Point C Contracted [320238]	$195 - $216	N/A
Medica Contracted [320239]	$204 - $215	N/A
Private Health Care Systems Contracted [320320]	$205 - $216	N/A
Point C [20238]	$205 - $216	N/A
Health Systems Inc Contracted [320174]	$205 - $216	N/A
Multiplan Contracted [320270]	$205 - $216	N/A
Reflect Health Contracted [320492]	$205 - $216	N/A
First Health Contracted [320128]	$205 - $216	N/A
Aither Health Contracted [320449]	$205 - $216	N/A
Imagine 360 Contracted [320494]	$205 - $216	N/A
Yuzu Health Contracted [320521]	$205 - $216	N/A
Insurance System Inc Contracted [320465]	$205 - $216	N/A
USA Managed Care Org Contracted [320429]	$205 - $216	N/A
90 Degree Benefits Contracted [320436]	$205 - $216	N/A
Ebms Contracted [320493]	$205 - $216	N/A
Show-Me Health Administrators Contracted [320483]	$205 - $216	N/A
Benefit Management Contracted [320052]	$205 - $216	N/A
Edison Health Solutions Contracted [320502]	$205 - $216	N/A
Evolutions Health Care Contracted [320124]	$205 - $216	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 $143.
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 Mercy St Francis 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.