CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $489
Cash Discount Price: $343
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Holy Cross Hospital - Salt Lake is $489. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $343. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$343

Average discount available for prompt cash payment at this facility.

Insurance Median

$489

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
Uuhp	$125 - $149	N/A
Centura Employee Plan	$236 - $364	N/A
Cigna	$241 - $833	N/A
Blue Cross Blue Shield	$250 - $625	N/A
Pehp	$287 - $1,041	N/A
Molina	$289 - $447	N/A
Aetna	$297 - $880	N/A
UnitedHealthcare	$309 - $478	N/A
Wise	$350 - $552	N/A
Multiplan	$397 - $948	N/A
Deseret Mutual Benefit Administrators	$413 - $639	N/A
Select Health	$445 - $689	N/A
Emi Health	$673 - $1,041	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 $343.
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 Holy Cross Hospital - Salt Lake 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.