CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Frisbie Memorial Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $553
Cash Discount Price: $1,612
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Frisbie Memorial Hospital is $553. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,612. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 11 Whitehall Road, Rochester, NH.

Cash / Self-Pay

$1,612

Average discount available for prompt cash payment at this facility.

Insurance Median

$553

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
Amerihealth Caritas	$133	N/A
Humana	$188	N/A
Martin's Point Health	$194	N/A
Well Sense Health Plan	$197	N/A
Blue Cross Blue Shield	$241 - $302	N/A
Harvard Pilgrim	$428 - $653	N/A
Maine Community Health	$460 - $779	N/A
Tufts Health Plan	$553 - $922	N/A
United	$553 - $972	N/A
Cigna	$570	N/A
Aetna	$932	N/A
Evernorth	$1,290	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 $1,612.
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 Frisbie 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.