CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Jones Memorial Hospital

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $138
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Jones Memorial Hospital is $138. 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 0.98x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $138 (98%)

Ins. Median: $138 (98% 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
UPMC Health Plan 5138	$101	72%
UnitedHealthcare	$134	96%
Humana	$134	96%
Total Senior Care 1319	$134	96%
Blue Cross Blue Shield	$134 - $262	96%
Medicare (plans)	$134 - $148	96%
Aetna	$142	101%
Independent Health 5156	$144	103%
Empire Plan 5179	$238	170%
Mvp 2900	$317	226%
Cigna	$328	234%

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 Jones 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.