CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Methodist Hospital Stone Oak

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $455
Cash Discount Price: $1,235
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Methodist Hospital Stone Oak is $455. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,235. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1139 E Sonterra Blvd,, San Antonio, TX.

Cash / Self-Pay

$1,235

Average discount available for prompt cash payment at this facility.

Insurance Median

$455

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
Superior Health	$62	N/A
Community First Health Plans	$148	N/A
Amerigroup	$173	N/A
Triwest Health Alliance	$204	N/A
Value Options	$204	N/A
United	$304 - $556	N/A
Blue Cross Blue Shield	$333 - $621	N/A
Cigna	$344 - $455	N/A
Superior	$457	N/A
Aetna	$618	N/A
National Choicecare	$618	N/A
Texas Healthcare Foundation Heb	$618	N/A
Tx Healthcare Foundation	$618	N/A
Healthsmart Preferred Care	$679	N/A
Independent Medical Systems	$679	N/A
Physician Cooperative of Texas	$679	N/A
Haa Preferred Partners	$741	N/A
Coastal Comp Health Networks	$803	N/A
National Healthcare Solutions	$803	N/A
Tml Intergovernmental Ebp	$865	N/A
Multiplan	$927 - $1,050	N/A
Triwest VA Pccc	$927	N/A
USA Managed Care	$927	N/A
Blue Bell	$988	N/A
Directcare America	$988	N/A
Managed Healthcare	$1,050	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 $1,235.
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 Methodist Hospital Stone Oak 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.