CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Sanford Westbrook Medical Center

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $125
Cash Discount Price: $120
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Sanford Westbrook Medical Center is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.

Cash / Self-Pay

$120

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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
Blue Cross Blue Shield	$36 - $139	N/A
Sanford Health Plan Align	$64	N/A
Wellmark Sd	$69	N/A
Ucare	$69 - $132	N/A
Medicare (plans)	$70	N/A
Aetna	$70 - $131	N/A
Health Partners	$70 - $120	N/A
UnitedHealthcare	$70 - $125	N/A
Primewest	$71 - $76	N/A
Security Health Plan	$83	N/A
Sanford Health Plan	$119 - $140	N/A
Medica	$132 - $142	N/A
Cigna	$135	N/A
First Choice Health Network	$135	N/A
Multiplan	$135	N/A
Healthez	$135	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 $120.
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 Sanford Westbrook 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.