CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Roundup Memorial Healthcare

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $80
Cash Discount Price: $160
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Roundup Memorial Healthcare is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $160. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1202 3Rd St W, Roundup, MT.

Cash / Self-Pay

$160

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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
Tricare	$2 - $154	N/A
VA Ccn - All Plans	$2 - $154	N/A
UnitedHealthcare	$2 - $154	N/A
Geha-All Plans	$4 - $258	N/A
Blue Cross Blue Shield	$4 - $315	N/A
Montana Health Co-Op Ppo/Pos - All Plans	$5 - $306	N/A
First Choice-All Plans	$5 - $306	N/A
Pacific Source-All Plans	$5 - $299	N/A
Multiplan-All Plans	$5 - $306	N/A
Ebms (Rmhn Network) - All Plans	$5 - $299	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 $160.
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 Roundup Memorial Healthcare 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.