CMS Price Transparency Data

Tdap vaccine (tetanus, diphtheria, pertussis)

Facility: Lewisgale Medical Center

Billing Code: 90715 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90715
Insurance Median: $172
Cash Discount Price: $242
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Tdap vaccine (tetanus, diphtheria, pertussis) at Lewisgale Medical Center is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $242. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1900 Electric Road, Salem, VA.

Cash / Self-Pay

$242

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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
Triatlantic	$33	N/A
Health Net	$35	N/A
Aetna	$36	N/A
Humana	$38	N/A
Cigna	$42 - $106	N/A
Virginia Health Network	$85 - $172	N/A
United	$88 - $119	N/A
Naphcare	$121	N/A
Greenvbrier Sporting Club	$145	N/A
Graham-White Manufacturing	$169	N/A
Richfield Nursing Center	$169	N/A
Corvel	$174	N/A
Community Care Network	$182	N/A
Richfield Retirement Community	$182	N/A
Occunet Workers Comp	$194	N/A
Csx Hotels	$194	N/A
One Health Plan	$194	N/A
Patients Choice	$213	N/A
Alleghany Highland Community	$218	N/A
PHCS	$218	N/A
Star Transportation	$218	N/A
4Most	$218	N/A
C&O Employees Hospital Assn	$218	N/A
Multiplan	$218	N/A
American Postal Workers Union	$218	N/A
United Behavioral Health	$242	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 $242.
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 Lewisgale 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.