CMS Price Transparency Data

Hepatitis B immune globulin

Facility: CHI St Lukes Health Memorial San Augustine

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $941
Cash Discount Price: $585
vs. Medicare Baseline: 6.71x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at CHI St Lukes Health Memorial San Augustine is $941. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $585. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 6.71x the Medicare baseline. Located in 511 Hospital St, San Augustine, TX.

Cash / Self-Pay

$585

Average discount available for prompt cash payment at this facility.

Insurance Median

$941

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: $585 (417%)

Insurance Median: $941 (671%)

Cash: $585 (417% of Medicare)

Ins. Median: $941 (671% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 671% of the Medicare baseline (a markup of 571%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$133 - $1,023	95%
Humana	$133 - $2,865	95%
Wellpoint	$137 - $195	98%
Cigna	$140 - $573	100%
Blue Cross Blue Shield	$142 - $333	101%
United	$142 - $4,093	101%
Scanhealth	$145	103%
Md Save	$166	118%
Angelina County	$357	255%
Brookshire Brothers	$383	273%
Entrust	$1,481 - $1,637	1056%
PHCS	$2,518 - $3,274	1796%
Multiplan	$2,592 - $2,865	1849%
Galaxy	$3,333 - $3,683	2377%

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 $585.
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 CHI St Lukes Health Memorial San Augustine 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.