CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Bristol Hospital

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $149
Cash Discount Price: $169
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Bristol Hospital is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $169. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 1.06x the Medicare baseline. Located in 41 Brewster Rd, Bristol, CT.

Cash / Self-Pay

$169

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$140.21

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $140.21 (100%)

Cash / Self-Pay: $169 (121%)

Insurance Median: $149 (106%)

Cash: $169 (121% of Medicare)

Ins. Median: $149 (106% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $140.21 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

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
Connecticare	$93 - $635	66%
Aetna	$110 - $143	78%
Blue Cross Blue Shield	$143 - $180	102%
UnitedHealthcare	$143 - $146	102%
Wellcare	$148	106%
Carepartners of Ct	$150	107%
Multiplan	$248	177%
Claim Doc	$286	204%
Cigna	$348	248%

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 $169.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90371.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Bristol Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90371.
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.