CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Pioneer Memorial Hospital - Cah

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $182
Cash Discount Price: $214
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Pioneer Memorial Hospital - Cah is $182. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $214. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 315 N Washington Ave Post Office Box 368, Viborg, SD.

Cash / Self-Pay

$214

Average discount available for prompt cash payment at this facility.

Insurance Median

$182

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
UnitedHealthcare	$75 - $180	N/A
Aetna	$169	N/A
Health Partners	$178	N/A
United Medical Resources	$180	N/A
Medica	$182	N/A
Cigna	$182	N/A
Dakotacare	$182	N/A
Avera Health Plan	$182	N/A
Sanford Health Plan	$193	N/A
Blue Cross Blue Shield	$205	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 $214.
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 Pioneer Memorial Hospital - Cah 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.