CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Methodist Southlake Medical Center

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $405
Cash Discount Price: $348
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Methodist Southlake Medical Center is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $348. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 421 E State Highway 114, Southlake, TX.

Cash / Self-Pay

$348

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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
UnitedHealthcare	$190 - $405	N/A
Aetna	$319 - $463	N/A
Evry Health [1013]	$339 - $356	N/A
Kempton Group Administrators, Tower Extrusions [3061]	$339 - $356	N/A
Blue Cross Blue Shield	$380 - $773	N/A
Scott & White Health Plan Trs [3062]	$380 - $399	N/A
Bind Benefits Inc [1004]	$386 - $405	N/A
Definity Health [3006]	$386 - $405	N/A
Freedom Life Insurance Company [2029]	$386 - $405	N/A
Geha Federal [3066]	$386 - $405	N/A
Tml Intergovernmental Employee Benefits [3050]	$386 - $405	N/A
Web Tpa [3049]	$386 - $534	N/A
Medical Cost Containment Professionals [3059]	$407 - $427	N/A
Provider Partners Health Plan [7025]	$407 - $427	N/A
Velocity [3070]	$441 - $463	N/A
Cigna	$508 - $534	N/A
Medicaid / KanCare	$702 - $895	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 $348.
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 Southlake 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.