CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Saint Mary's Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $444
Cash Discount Price: $576
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Saint Mary's Hospital is $444. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $576. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 56 Franklin Street, Waterbury, CT.

Cash / Self-Pay

$576

Average discount available for prompt cash payment at this facility.

Insurance Median

$444

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	$112 - $130	N/A
Medicare (plans)	$141 - $317	N/A
Unicare	$144	N/A
Wellpoint	$144	N/A
Connecticut Dept of Correction	$145	N/A
Aetna	$176	N/A
Allegiance	$243	N/A
Cigna	$243 - $461	N/A
Health Partners	$243	N/A
Magnacare	$243	N/A
Carelon Behavioral Health	$288	N/A
Geha	$288	N/A
Harvard Pilgrim Healthcare	$288	N/A
UnitedHealthcare	$288 - $576	N/A
Health New England	$306	N/A
Claimdoc	$346	N/A
Diversified Administrators	$346	N/A
Innovative Health Plan II	$346	N/A
Centivo	$432	N/A
Allied National Global Care	$444	N/A
Asrm - Reliance Standard Life Insurance	$444	N/A
Christian Care Ministry	$444	N/A
Dean Health	$444	N/A
Fallon Health	$444	N/A
Family Life Insurance Company	$444	N/A
Ghc Scw	$444	N/A
International Benefit Administrators	$444	N/A
Lifetime Benefit Solutions	$444	N/A
Manhattan Life	$444	N/A
Medi Share	$444	N/A
Multiplan	$444	N/A
Mvp	$444	N/A
PHCS	$444	N/A
Pai	$444	N/A
Pan-American Life	$444	N/A
Paramount HMO	$444	N/A
Trinity Health Share	$444	N/A
Prime Health Services	$461	N/A
Health Smart	$490	N/A
Connecticare	$546 - $564	N/A
United Behavioral Health Eap	$576	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 $576.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90716.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Saint Mary's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90716.
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.