CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: New London Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $194
Cash Discount Price: $139
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at New London Hospital is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 273 County Road, New London, NH.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

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
Wellsense Health Plan	$122 - $147	N/A
Martin's Point Health Care	$131 - $209	N/A
Aetna	$134 - $263	N/A
Martin's Point Generations Advantage	$134	N/A
Blue Cross Blue Shield	$134 - $486	N/A
Ambetter / Centene	$134	N/A
Wellcare Health Plans	$134	N/A
UnitedHealthcare	$134 - $395	N/A
Granite State Health Plan	$147 - $154	N/A
Amerihealth Caritas Nh	$148 - $155	N/A
Harvard Pilgrim Health Care of Ne	$156 - $217	N/A
Cigna	$206	N/A
Tufts Health Plan	$210 - $219	N/A
Coventry	$288	N/A
Multiplan	$289	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 $139.
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 New London Hospital 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.