CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $330
Cash Discount Price: $186
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Mary Hitchcock Memorial Hospital is $330. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $186. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$186

Average discount available for prompt cash payment at this facility.

Insurance Median

$330

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
Amerihealth Caritas Nh	$69	N/A
Beacon Health Strategies/Carelon	$74	N/A
Wellsense Health Plan	$74 - $163	N/A
Granite State Health Plan	$77	N/A
Harvard Pilgrim Health Care of Ne	$121 - $664	N/A
UnitedHealthcare	$135 - $467	N/A
Tufts Health Plan	$142 - $355	N/A
Aetna	$154 - $427	N/A
Cigna	$160 - $418	N/A
Blue Cross Blue Shield	$163 - $530	N/A
Martin's Point Health Care	$194 - $210	N/A
Mass General Brigham Health Plan	$216 - $379	N/A
Maine Community Health Options	$388 - $447	N/A
Mvp	$408	N/A
Coventry	$530	N/A
First Health/Hcvm	$530	N/A
PHCS	$548	N/A
Corvel	$560	N/A
Ccmsi	$578	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 $186.
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 Mary Hitchcock Memorial 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.