CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Samaritan Lebanon Community Hospital

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $168
Cash Discount Price: $734
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Samaritan Lebanon Community Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $734. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 1.20x the Medicare baseline. Located in 525 N Santiam Highway, Lebanon, OR.

Cash / Self-Pay

$734

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $734 (524%)

Insurance Median: $168 (120%)

Cash: $734 (524% of Medicare)

Ins. Median: $168 (120% 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
Providence	$134 - $1,239	96%
Samaritan	$134 - $1,085	96%
Pacificsource	$148 - $415	106%
Devoted Health	$154 - $426	110%
First Choice	$154	110%
Healthnet	$154 - $1,239	110%
Humana	$154	110%
Cigna	$164 - $1,239	117%
Regence	$168 - $1,148	120%
Moda	$174	124%
Aetna	$179 - $1,213	128%
Ihn	$638	455%

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 $734.
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 Samaritan Lebanon Community 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.