CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Hackensack Meridian Mountainside Medical

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $469
Cash Discount Price: $948
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Hackensack Meridian Mountainside Medical is $469. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $948. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Bay Avenue, Montclair, NJ.

Cash / Self-Pay

$948

Average discount available for prompt cash payment at this facility.

Insurance Median

$469

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
Healthscope Benefits [2290]	$100 - $806	N/A
UnitedHealthcare	$100	N/A
National Association of Letter Carriers [1695]	$275	N/A
Mvp Health Plan [2180]	$275	N/A
Samba Health [2305]	$275	N/A
Cigna	$275	N/A
Amerihealth [3520]	$379	N/A
Wtc Healthcare Sme Karna [8005]	$389	N/A
Black Lung [6055]	$389	N/A
Oncology Patient Assistance Programs [2295]	$389	N/A
Worker's Comp [2125]	$389	N/A
Medicare (plans)	$389	N/A
Create Flex / Select [3580]	$389	N/A
Web Tpa [2115]	$389 - $469	N/A
Healthcare Highways [2210]	$389 - $806	N/A
Selecthealth [3740]	$389	N/A
Lucent Health [6000]	$389	N/A
Aetna	$423 - $469	N/A
Meritain Health [1655]	$469	N/A
1199 Seiu Benefit Fund [3505]	$469	N/A
Allied Benefit Systems Inc [1030]	$469	N/A
Medicaid / KanCare	$474	N/A
First Health [1375]	$711 - $806	N/A
Planned Administrators Inc [2360]	$806	N/A
Healthfirst [2395]	$806	N/A
Mayo Clinic Health Solutions [2280]	$806	N/A
Resource One Administrators [2815]	$806	N/A
Universal Fidelity [2085]	$806	N/A
Administrative Concepts [1005]	$806	N/A
Pba [1775]	$806	N/A
Trustmark [2030]	$806	N/A
Healthcost Solutions [2415]	$806	N/A
Healthnet [1495]	$806	N/A
PHCS [1780]	$806	N/A
Hometown Health [2155]	$806	N/A
Mutual of Omaha [1685]	$806	N/A
Gilsbar [1425]	$806	N/A
Multiplan [1680]	$806	N/A
New Era Life Insurance Company [1705]	$806	N/A
Pan American Life Insurance Co [1770]	$806	N/A
Allied National Global Care [1035]	$806	N/A
Mva [1690]	$948	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 $948.
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 Hackensack Meridian Mountainside Medical 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.