CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Memorial Hospital of Carbon County

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $576
Cash Discount Price: $480
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Memorial Hospital of Carbon County is $576. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $480. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2221 West Elm Street, Rawlins, WY.

Cash / Self-Pay

$480

Average discount available for prompt cash payment at this facility.

Insurance Median

$576

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
Blue Cross Blue Shield	$333 - $589	N/A
Medicare (plans)	$333	N/A
Vaccn	$333	N/A
Three_River_Providers_Network	$480	N/A
Wise_Provider_Networks	$480	N/A
Zelis	$480	N/A
Corechoice	$576	N/A
First_Choice_Health	$576	N/A
Cigna	$595	N/A
UnitedHealthcare	$614	N/A
Interwests_Ppo_Network	$621	N/A
Multiplan	$621	N/A
Medicaid / KanCare	$640	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 $480.
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 Memorial Hospital of Carbon County 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.