CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Sky Lakes Medical Center

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $268
Cash Discount Price: $201
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Sky Lakes Medical Center is $268. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $201. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2865 Daggett Avenue, Klamath Falls, OR.

Cash / Self-Pay

$201

Average discount available for prompt cash payment at this facility.

Insurance Median

$268

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

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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
Cco Cascade Health Alliance [5006]	$113	N/A
Providence Health Plan [1078]	$215	N/A
Moda Health [1070]	$221 - $268	N/A
Blue Cross Blue Shield	$227 - $268	N/A
Pacificsource Health Plan PPO [1072]	$241	N/A
Pacificsource [1195]	$241	N/A
Crime Victims Comp Program [8002]	$268	N/A
Healthcare Management Admin [1109]	$268	N/A
Plumbers and Pipefitters Union [1083]	$268	N/A
United Indian Health Services [1211]	$268	N/A
Country Companies [6008]	$268	N/A
City County Ins Service [6007]	$268	N/A
So Ca Drug Benefit Fund [1133]	$268	N/A
Cco Health Share Tuality [5028]	$268	N/A
Mediplus Troa Claims [1064]	$268	N/A
Aflac Med Supp [1234]	$268	N/A
Ufcw [1095]	$268	N/A
Loomis [1060]	$268	N/A
Bridgespan Health [1213]	$268	N/A
Healthnet Med Supp [1149]	$268	N/A
Union Pacific Rr Emp Health [1096]	$268	N/A
Tantara [1110]	$268	N/A
Construction Teamsters [1123]	$268	N/A
Meritain Health [1129]	$268	N/A
Cco Health Share Oregon [5030]	$268	N/A
Providence Health Assur Med Supp [1079]	$268	N/A
Globe Life and Accident Ins Co [1177]	$268	N/A
Iec Benefit Administrators [1052]	$268	N/A
Humana	$268	N/A
Lineco Ins First Health [1059]	$268	N/A
Lumico Life Insurance [1183]	$268	N/A
Ohp Newborn Pending Id [8006]	$268	N/A
Broadspire [6034]	$268	N/A
Select Health Plan PPO [1132]	$268	N/A
Medicaid / KanCare	$268	N/A
Mba Merchants Benefit Admin [1247]	$268	N/A
Farmers Ins Medical [1033]	$268	N/A
Us Family Health Plan [4007]	$268	N/A
Aig Workers Compensation [6000]	$268	N/A
Cambridge Integrated Service [6004]	$268	N/A
Us Department of Labor [6036]	$268	N/A
Sky Lakes Health Plan [1156]	$268	N/A
Partnership Healthplan of Ca [5033]	$268	N/A
Ameriben Solutions [1007]	$268	N/A
United Teacher Assoc Ins Co [1171]	$268	N/A
Allied Benefit Systems [1158]	$268	N/A
Allcare Medigap [1162]	$268	N/A
Mvp Select Care [1140]	$268	N/A
Gravie Administrative Services [1249]	$268	N/A
Cco Umpqua Health Alliance [5008]	$268	N/A
Aetna	$268	N/A
Boilermaker Natl Hlth and Wlfr [1020]	$268	N/A
Esis [6047]	$268	N/A
Argo Group Us Wc Claims [6002]	$268	N/A
S&S Health Tpa PPO [1219]	$268	N/A
Nationwide Ins [3051]	$268	N/A
Auic Org [1118]	$268	N/A
Cna Workers Compensation [6056]	$268	N/A
Gpa [1193]	$268	N/A
Teamsters Food Employers Sec [1136]	$268	N/A
Ebms [1031]	$268	N/A
Liberty Mutual [6016]	$268	N/A
Blue Shield Out of State PPO [1235]	$268	N/A
Iac [1157]	$268	N/A
Veterans Evaluation Services [4008]	$268	N/A
Bakery and Confectionery Union [1119]	$268	N/A
Tristar Insurance Group [6042]	$268	N/A
Managed Care Administrators [1128]	$268	N/A
Asuris Northwest Health [1117]	$268	N/A
Kaiser Permanente [3047]	$268	N/A
Special District Assoc of Or [6024]	$268	N/A
The General [3055]	$268	N/A
Josephine County [6030]	$268	N/A
Kaiser Covered California [5035]	$268	N/A
Uct Insurance [1094]	$268	N/A
Geha [1038]	$268	N/A
State of Oregon [5019]	$268	N/A
Allstate Mva [6001]	$268	N/A
Sublimity Insurance [6028]	$268	N/A
Specialty Risk Solutions [6025]	$268	N/A
Usaa Ins [1098]	$268	N/A
Washington Dept of Labor & Ind [6051]	$268	N/A
Health Now Admin Services [1120]	$268	N/A
Greater Oregon Behavioral Hlth [5001]	$268	N/A
Cigna	$268	N/A
Corvel [3066]	$268	N/A
Plexis Healthcare Systems [1246]	$268	N/A
Ag Specialty Insurance [1242]	$268	N/A
Blue Shield Covered California [1241]	$268	N/A
Ohp Marion Polk Comm Health Pl [5012]	$268	N/A
Cco Yamhill Community Care Org [5032]	$268	N/A
Mega Life and Hlth [1065]	$268	N/A
Sentinel Security Life Insurance [1189]	$268	N/A
Alaska Electrical [1003]	$268	N/A
Triwest [4006]	$268	N/A
Cypress Benefit Administrators [1179]	$268	N/A
Tribal Health Coquille [1088]	$268	N/A
Cco Intercommunity Health Network [5010]	$268	N/A
Cco Advanced Health [5027]	$268	N/A
Dairyland Auto Ins [6010]	$268	N/A
Principal Life Insurance [1077]	$268	N/A
Pemco Mutual Insurance [6044]	$268	N/A
State Farm Health [1084]	$268	N/A
Sbma [1252]	$268	N/A
Medicare (plans)	$268	N/A
Samba [1082]	$268	N/A
Healthnet PPO [1047]	$268	N/A
Woodmen Life Supplement [1248]	$268	N/A
Chartis [6006]	$268	N/A
Pyramid Life Insurance [1080]	$268	N/A
Western Growers Assurance Trust [3053]	$268	N/A
University of Utah Health Plans [1212]	$268	N/A
Cco Eastern Oregon [5023]	$268	N/A
Plumbing and Pipefitting Trst [1076]	$268	N/A
American Family Auto [3033]	$268	N/A
Root Insurance Company [6048]	$268	N/A
Transamerica Gap Supplement [1186]	$268	N/A
Washington National Ins [1099]	$268	N/A
Bristol Hospice [1206]	$268	N/A
Usaa Auto Insurance [3048]	$268	N/A
Nationwide Worker's Comp [3032]	$268	N/A
Enumclaw Property & Casualty [6045]	$268	N/A
Western Benefits [1101]	$268	N/A
Continental Benefits [1196]	$268	N/A
Oregon State Police [8004]	$268	N/A
Pai [1130]	$268	N/A
Screenwise Program [5017]	$268	N/A
Asante Hospice [1048]	$268	N/A
Office Workers Com [6018]	$268	N/A
Cco Jackson Care Connect [5005]	$268	N/A
Travelers Insurance Oregon Mva [6050]	$268	N/A
UPMC Health Plan [1228]	$268	N/A
Verdegard Administrators LLC [1204]	$268	N/A
Hartford [6015]	$268	N/A
Cas Tpa [1210]	$268	N/A
Kaiser Northern California HMO [1223]	$268	N/A
G and G Electric Healthcare Plan [1036]	$268	N/A
Cco Health Share Kaiser [5031]	$268	N/A
Medi Cal [5002]	$268	N/A
Lifewise Tpm Trust [1058]	$268	N/A
Delta Health System [1107]	$268	N/A
Motion Picture Health [1066]	$268	N/A
Sanford Health Plan [1147]	$268	N/A
Kemper Auto [3062]	$268	N/A
Gallagher Bassett [6013]	$268	N/A
Eob Tpa LLC [1250]	$268	N/A
State Comp of Ca [6026]	$268	N/A
Claims Administrator Lucent Health [1188]	$268	N/A
North America Administrators [1174]	$268	N/A
Kaiser Permanente [1056]	$268	N/A
First Choice Health PPO [1220]	$268	N/A
Web Tpa [1170]	$268	N/A
Cco Columbia Pacific [5026]	$268	N/A
Physicians Mutual Ins [1074]	$268	N/A
Aither Health Plan [1243]	$268	N/A
Us Department of Labor [6011]	$268	N/A
Providence Health Ph & S Oregon [3036]	$268	N/A
Personify Health [1125]	$268	N/A
Kaiser Permanente Hawaii [3050]	$268	N/A
Trustmark [1209]	$268	N/A
UnitedHealthcare	$268	N/A
Pioneer Life [1075]	$268	N/A
Options for Southern Oregon [5022]	$268	N/A
Starr Indemnity and Liability [1134]	$268	N/A
Asante Moda Health Plan [1245]	$268	N/A
Phillips Admin Service [1073]	$268	N/A
Champva [4001]	$268	N/A
National General Accident Health [1202]	$268	N/A
Wells Fargo Insurance Services [1139]	$268	N/A
Us Marshals Office [8005]	$268	N/A
Farmers Insurance [6012]	$268	N/A
Crawford and Co [6009]	$268	N/A
Imagine 360 [1251]	$268	N/A
Standard Life and Accident Ins [1167]	$268	N/A
Teamsters Food Employers Med Supp [1239]	$268	N/A
Mutual of Omaha [1068]	$268	N/A
Managed Hlth Netwrk Bh Healthnet [1233]	$268	N/A
State Mutual Insurance Company [1173]	$268	N/A
Thrivent Financial [1176]	$268	N/A
Careassist Program/Tpa [1165]	$268	N/A
Safeco [6021]	$268	N/A
Mailhandlers Benefit [1062]	$268	N/A
National Guardian Life [1208]	$268	N/A
Joint Labor Mgmt Retail Trust [1055]	$268	N/A
Avma Health Group 1St Hlth PPO [1016]	$268	N/A
Mba Benefit Administrators [1253]	$268	N/A
Lucent Health [1187]	$268	N/A
Zenith Admin [1104]	$268	N/A
Cannon Cochran Mgmt [6005]	$268	N/A
Cco Trillium Community Health Plan [5011]	$268	N/A
Alaska Teamster [1116]	$268	N/A
Sierra Health and Life [1200]	$268	N/A
Wausau Ins [1100]	$268	N/A
Saif [6022]	$268	N/A
Cco Health Share OHSU [5041]	$268	N/A
Cco Pacifisource Community Sol [5016]	$268	N/A
Western Teamsters Welfare [1103]	$268	N/A
Contra Costa Health [5038]	$268	N/A
Bs of Ca Promise Health Plan [5039]	$268	N/A
Albertson [1004]	$268	N/A
Transamerica Life Ins [1087]	$268	N/A
Healthpartners [1192]	$268	N/A
Claimsbridge Ath01 [1254]	$268	N/A
Cco Allcare Health Plan [5013]	$268	N/A
Kaiser of Washington [1207]	$268	N/A
Medico Insurance Company [1194]	$268	N/A
Amshield [6057]	$268	N/A
Liberty Health Plan [1057]	$268	N/A
Tribal Health Klamath [1091]	$268	N/A
Tribal Health Karuk [1090]	$268	N/A
Standard Life [1169]	$268	N/A
Matrix Absence Management Inc [6038]	$268	N/A
International Benefit Administrator [1172]	$268	N/A
Zurich North America - Claims [6058]	$268	N/A
United American Ins [1097]	$268	N/A
Ilwu Pma Welfare Plan [1053]	$268	N/A
Providence Health Plan Bh [1205]	$268	N/A
Travelers Insurance Oregon Wc [6035]	$268	N/A
Samaritan Health Plan [3043]	$268	N/A
Tcc of South Carolina [1135]	$268	N/A
Shasta Administrators [1092]	$268	N/A
Covered California [5040]	$268	N/A
Liberty Mutual [6049]	$268	N/A
Jackson County [8003]	$268	N/A
Arkansas Walmart Claims Mgmt [6003]	$268	N/A
Met Life Mva [3045]	$268	N/A
Harrington Benefit Services [1043]	$268	N/A
Fra Ins Plans [1035]	$268	N/A
Sedgwick Cms [6023]	$268	N/A
American National [1178]	$268	N/A
Intermountain Claims [6014]	$268	N/A
Veterans Administration [4004]	$268	N/A
Coordinated Benefit Plans [1124]	$268	N/A
State Farm [6027]	$268	N/A
Operating Engineers [1071]	$268	N/A
Geico [6032]	$268	N/A
Zurich Farmers [6029]	$268	N/A
Masters Mates and Pilots [1063]	$268	N/A
Deseret Mutual Mhn [1030]	$268	N/A
Tricare	$268	N/A
Providence Hospice [1050]	$268	N/A
Combined Insurance [1106]	$268	N/A
Equitable [1032]	$268	N/A
Connecticut General Life [1122]	$268	N/A
Oregon Mutual Insurance Co [6019]	$268	N/A
Hartford Auto Insurance [3049]	$268	N/A
Ohp Doctors of Oregon Coast So [5007]	$268	N/A
Rsl Specialty Products Admin [1131]	$268	N/A
Nonstop Wellness [3044]	$268	N/A
Teamsters Benefit Trust [1190]	$268	N/A
Progressive Auto [6020]	$268	N/A
Healthscope [1126]	$268	N/A
Central States Idemnity Med Supp [1143]	$268	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 $201.
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 Sky Lakes 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.