CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: CHI St Lukes Lakeside Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $85
Cash Discount Price: $46
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at CHI St Lukes Lakeside Hospital is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 17400 St Lukes Way, The Woodlands, TX.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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
Aetna	$29 - $42	N/A
United	$34 - $472	N/A
UnitedHealthcare	$35 - $108	N/A
Bright Health	$43	N/A
Tchpchip	$46 - $58	N/A
Cigna	$47 - $131	N/A
Humana	$63 - $85	N/A
Kelseycare	$64	N/A
Chc	$72	N/A
Texastruechoice	$72	N/A
Independent Med System	$78	N/A
Coventry	$85	N/A
First Health	$85	N/A
Healthsmart	$92	N/A
Interlink	$92	N/A
PHCS	$92	N/A
PHCS Savility	$92	N/A
Multiplan	$98	N/A
USA Health Network	$111	N/A
Blue Cross Blue Shield	$131	N/A
Mhealth Network	$131	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 $46.
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 CHI St Lukes Lakeside 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.