CMS Price Transparency Data

Varicella (chickenpox) vaccine

Facility: Stonewall Jackson Memorial Hospital

Billing Code: 90716 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90716
Insurance Median: $647
Cash Discount Price: $405
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Varicella (chickenpox) vaccine at Stonewall Jackson Memorial Hospital is $647. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $405. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 230 Hospital Plaza, Weston, WV.

Cash / Self-Pay

$405

Average discount available for prompt cash payment at this facility.

Insurance Median

$647

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
Aetna	$138 - $767	N/A
Onenet	$570 - $828	N/A
Healthsmart_Accel	$594 - $863	N/A
Sharpe	$594 - $863	N/A
Healthsmart_Ppo	$594 - $863	N/A
Healthsmart_Auto	$594 - $863	N/A
Healthsmart_Hpo	$594 - $863	N/A
Cigna	$596 - $865	N/A
UnitedHealthcare	$614 - $892	N/A
Multiplan	$627 - $911	N/A
Alliance_Ppo	$627 - $911	N/A
Ccn	$627 - $911	N/A
Napp	$644 - $935	N/A
4_Most	$647 - $940	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 $405.
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 Stonewall Jackson 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.