CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Newton Medical Center

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $358
Cash Discount Price: $243
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Newton Medical Center is $358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $243. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 175 High St, Newton, NJ.

Cash / Self-Pay

$243

Average discount available for prompt cash payment at this facility.

Insurance Median

$358

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
Horizon Nj Health [5021]	$72 - $183	N/A
Cosmetic Surgery/Lap Band/Gastric Bypass [5289]	$78 - $359	N/A
Fairos [5491]	$78	N/A
Karen Ann Quinlan [5285]	$78	N/A
Medicaid / KanCare	$78 - $359	N/A
Specialty Imaging [5433]	$78 - $359	N/A
Aetna	$83 - $1,827	N/A
Amerihealth Administrators Supplemental [5512]	$83 - $643	N/A
Amerihealth Caritas Vip Care Ip Splits [5460]	$83	N/A
Amerihealth Caritas Vip Care [5313]	$83	N/A
Amerihealth Medigap [5049]	$83 - $643	N/A
Claimdoc [5434]	$83	N/A
Highmark Wholecare Health Plan Ip Splits [5464]	$83	N/A
Highmark Wholecare Health Plan [5413]	$83	N/A
Luminare Health AHS Retiree [5013]	$83	N/A
Medicare (plans)	$83 - $313	N/A
Sedgwick Wtc Health Program Wc [5514]	$83	N/A
UPMC [5455]	$83	N/A
VA Community Care Network [5403]	$83	N/A
Wellcare Behavioral Health [5335]	$83	N/A
Wellcare Health Plans Ip Splits [5475]	$83	N/A
Wellcare Health Plans [5269]	$83	N/A
Kindred Giralda Hospital [5341]	$91	N/A
Tricare	$92 - $96	N/A
Champva [5354]	$96	N/A
Us Family Health Plan [5258]	$96	N/A
Cigna	$163 - $313	N/A
Allstate [5047]	$183	N/A
Church Mutual Wc Insurance Company [5524]	$183	N/A
Esurance No Fault [5105]	$183	N/A
Geico No Fault [5120]	$183	N/A
Hanover No Fault [5129]	$183	N/A
Hanover Workers Comp [5130]	$183	N/A
Hartford Worker's Compensation [5132]	$183	N/A
Hcs Network Solutions [5148]	$183	N/A
Liberty Mutual No Fault [5173]	$183	N/A
Nj Manufacturers No Fault [5203]	$183	N/A
Nj Manufacturers Workers Comp [5204]	$183	N/A
Progressive No Fault [5229]	$183	N/A
Selective Ins Workers Comp [5237]	$183	N/A
State Farm No Fault [5241]	$183	N/A
Strategic Comp [5518]	$183	N/A
Travelers No Fault [5249]	$183	N/A
Usaa No Fault [5260]	$183	N/A
Zurich No Fault [5274]	$183	N/A
Zurich Workers Comp [5275]	$183	N/A
Evolution Healthcare [5438]	$192 - $1,827	N/A
Healthez [5445]	$192 - $1,827	N/A
Mvp Health Care [5197]	$192	N/A
Nalc [5198]	$192	N/A
Seafarers Health and Benefits Plan [5343]	$192	N/A
Tufts Health Plan [5344]	$192	N/A
Webtpa [5447]	$192 - $1,827	N/A
Blue Cross Blue Shield	$204 - $2,067	N/A
Allied Benefit Systems [5046]	$211 - $1,827	N/A
Centivo [5405]	$211	N/A
Iaa - Insurance Administrators of America [5482]	$211	N/A
Untd Hlth Community Plan Behavioral Health [5293]	$225	N/A
Untd Hlth Community Plan [5034]	$225	N/A
Wtc Health Program [5273]	$229	N/A
Independence Bc [5479]	$479	N/A
Prime Healthcare [5435]	$479	N/A
Amerihealth [5008]	$632	N/A
Ghi Emblem Health [5122]	$1,066	N/A
Humana	$1,066	N/A
Ila Local 1478-2 Welfare Fund [5448]	$1,066	N/A
Oscar [5213]	$1,066	N/A
Qualcare [5026]	$1,066 - $1,757	N/A
Claim Watcher/Homestead [5488]	$1,522	N/A
First Managed Care Option [5109]	$1,522 - $2,588	N/A
Inservco Workers Compensation [5158]	$1,522 - $2,588	N/A
Magnacare [5177]	$1,522	N/A
Medlogix/Consumer Health Network (Chn) [5415]	$1,522 - $2,588	N/A
Occunet [5490]	$1,522	N/A
Praxis Workers Comp [5515]	$1,522 - $1,675	N/A
The Fairly Group [5528]	$1,522	N/A
Aig Workers Compensation [5045]	$1,675	N/A
Amtrust North America Inc [5521]	$1,675	N/A
Berkshire Hathaway Guard Insurance Company [5529]	$1,675	N/A
Broadspire Workers Comp [5357]	$1,675	N/A
Ccmsi Wc [5525]	$1,675	N/A
Continental Assurance - PHCS [5092]	$1,675	N/A
Continental Casualty PHCS [5094]	$1,675	N/A
Coresource [5014]	$1,675	N/A
Kaiser Permanente [5162]	$1,675	N/A
Nationwide Mutual Insurance Company [5526]	$1,675	N/A
Private Healthcare Systems PPO (PHCS) [5227]	$1,675	N/A
Qual-Lynx Wc Preferred [5230]	$1,675	N/A
Qual-Lynx Wc Standard [5028]	$1,675	N/A
Sage Adjusting, LLC [5527]	$1,675	N/A
1199 Seiu Benefit and Pension [5037]	$1,827	N/A
Banner Health Network [5510]	$1,827	N/A
Boon-Chapman [5441]	$1,827	N/A
Christian Brothers Services [5439]	$1,827	N/A
Continental Assurance [5091]	$1,827	N/A
Healthsmart Benefit Solutions [5446]	$1,827	N/A
Luminare Health Benefits [5483]	$1,827	N/A
Marpai Health [5449]	$1,827	N/A
Meritain Health [5185]	$1,827	N/A
Nippon Benefit Life [5201]	$1,827	N/A
Occunet Secondary [5517]	$1,827	N/A
Starmark [5240]	$1,827	N/A
The Fairly Group Secondary [5531]	$1,827	N/A
First Health Network [5108]	$1,979	N/A
Gallagher Bassett Workers Comp [5117]	$1,979	N/A
Liberty Mutual Worker's Comp [5174]	$1,979	N/A
Pma Workers Comp [5224]	$1,979	N/A
Sedgwick [5235]	$1,979	N/A
Sentry Worker's Comp [5489]	$1,979	N/A
Travelers Workers Compensation [5250]	$1,979	N/A
Ambetter / Centene	$2,040	N/A
Multiplan [5194]	$2,131	N/A
One Call Workers Comp [5418]	$2,131	N/A
High Point No Fault [5146]	$2,436	N/A
Medlogix/Consumer Health Network Pip (Chn) [5414]	$2,436	N/A
Plymouth Rock Assurance No Fault [5222]	$2,436	N/A
Chubb Worker's Compensation [5075]	$2,588	N/A
Claims Resolution Corporation Inc [5520]	$2,588	N/A
Corvel Corporation [5522]	$2,588	N/A
Esis [5519]	$2,588	N/A
Medrisk/Spnet Worker's Comp [5452]	$2,588	N/A
Atlantic Home Care and Hospice [5055]	$3,045	N/A
Bundled Cases/Episodic Payment [5492]	$3,045	N/A
Carba R Generic [5530]	$3,045	N/A
Carisk Worker's Comp [5501]	$3,045	N/A
Kessler Foundation [5532]	$3,045	N/A
Streamline Worker's Comp [5540]	$3,045	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 $243.
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 Newton Medical Center 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.