CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Cheshire Medical Center

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $277
Cash Discount Price: $168
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Cheshire Medical Center is $277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$277

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
Amerihealth Caritas Nh	$74 - $130	N/A
Wellsense Health Plan	$84 - $130	N/A
Granite State Health Plan	$102 - $130	N/A
Harvard Pilgrim Health Care of Ne	$130 - $277	N/A
Tufts Health Plan	$142 - $388	N/A
UnitedHealthcare	$143 - $462	N/A
Martin's Point Health Care	$151	N/A
Aetna	$163 - $416	N/A
Blue Cross Blue Shield	$175 - $483	N/A
Mvp	$179 - $301	N/A
Cigna	$179 - $301	N/A
Mass General Brigham Health Plan	$208 - $609	N/A
Maine Community Health Options	$274	N/A
First Health/Hcvm	$517	N/A
PHCS	$548	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 $168.
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 Cheshire 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.