CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Mount Sinai Rehabilitation Hospital Inc

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $346
Cash Discount Price: $576
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Mount Sinai Rehabilitation Hospital Inc is $346. 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 490 Blue Hills Ave, Hartford, CT.

Cash / Self-Pay

$576

Average discount available for prompt cash payment at this facility.

Insurance Median

$346

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
Blue Cross Blue Shield	$124 - $159	N/A
Blue Shield - Id (Regence)	$159	N/A
Blue Care Network	$159	N/A
Blue Shield - Ny Highmark Western	$159	N/A
Unicare	$159	N/A
Kaiser Domestic	$159	N/A
Pre-Employment	$159	N/A
Blue Shield - PA (Highmark)	$159	N/A
Blue Shield - Wa (Regence)	$159	N/A
Blue Distinction Transplant	$159	N/A
Blue Shield - Ny Highmark Northeastern	$159	N/A
Bcn Domestic	$159	N/A
Wc Domestic	$159	N/A
Blue Shield - Ca	$159	N/A
Health Choices	$159	N/A
Blue Benefit Administrators of Massachusetts	$159	N/A
Medicare (plans)	$202 - $576	N/A
Connecticare	$222 - $245	N/A
Magnacare	$243	N/A
Cigna	$243	N/A
Health Partners	$243	N/A
Allegiance	$243	N/A
Connecticut Dept of Correction	$250	N/A
Geha	$288	N/A
UnitedHealthcare	$288	N/A
Harvard Pilgrim Healthcare	$288	N/A
Health New England	$306	N/A
Diversified Administrators	$346	N/A
Claimdoc	$346	N/A
Innovative Health Plan II	$346	N/A
Aetna	$373 - $467	N/A
Trinity Health Share	$392	N/A
Paramount HMO	$392	N/A
Lifetime Benefit Solutions	$392	N/A
Medi Share	$392	N/A
Manhattan Life	$392	N/A
Pai	$392	N/A
Family Life Insurance Company	$392	N/A
International Benefit Administrators	$392	N/A
Dean Health	$392	N/A
Ghc Scw	$392	N/A
Asrm - Reliance Standard Life Insurance	$392	N/A
Christian Care Ministry	$392	N/A
Allied National Global Care	$392	N/A
Pan-American Life	$392	N/A
Multiplan	$392	N/A
PHCS	$392	N/A
Mvp	$392	N/A
Prime Health Services	$461	N/A
Webtpa	$467	N/A
Allied Benefit Systems	$467	N/A
Meritain	$467	N/A
Nippon Life Ins	$467	N/A
Luminare Health	$467	N/A
1199 National Benefit Fund	$467	N/A
Gravie Admin Services	$467	N/A
Hap	$467	N/A
Health Smart	$490	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 Mount Sinai Rehabilitation Hospital Inc 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.