CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $161
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Mary Hitchcock Memorial Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 1.15x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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%)

Insurance Median: $161 (115%)

Ins. Median: $161 (115% 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
Harvard Pilgrim Health Care of Ne	$95 - $521	68%
Aetna	$126 - $198	90%
UnitedHealthcare	$128 - $556	91%
Mvp	$134 - $162	96%
Blue Cross Blue Shield	$134 - $1,030	96%
Martin's Point Generations Advantage	$134	96%
Tufts Health Plan	$135 - $150	96%
Wellsense Health Plan	$135 - $822	96%
Cigna	$138 - $324	98%
Wellcare Health Plans	$140	100%
Ambetter / Centene	$141 - $441	101%
Martin's Point Health Care	$143 - $146	102%
Beacon Health Strategies/Carelon	$167 - $822	119%
Amerihealth Caritas Nh	$172 - $822	123%
Granite State Health Plan	$172 - $822	123%
Mass General Brigham Health Plan	$306	218%

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 $X.
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 Mary Hitchcock Memorial 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.