CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Ira Davenport Memorial Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $115
Cash Discount Price: $154
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Ira Davenport Memorial Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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	$67 - $467	N/A
Fidelis Care - Exchange - All Plans	$85	N/A
Geisinger - All Plans	$90	N/A
Mvp Health Plan - All Plans	$96	N/A
Cigna	$96	N/A
Independent Health - All Plans	$100	N/A
UPMC - All Plans	$106	N/A
Pomco Inc - All Plans	$111	N/A
UnitedHealthcare	$115	N/A
Aetna	$115	N/A
Emblem Health - All Plans	$135	N/A
Humana	$139	N/A
Martins Point - All Plans	$154	N/A
Empire	$227	N/A
Healthnow - All Plans	$507	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 $154.
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 Ira Davenport Memorial 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.