CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $778
Cash Discount Price: $401
vs. Medicare Baseline: 5.55x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Holy Cross Hospital - Salt Lake is $778. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $401. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 5.55x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$401

Average discount available for prompt cash payment at this facility.

Insurance Median

$778

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: $401 (286%)

Insurance Median: $778 (555%)

Cash: $401 (286% of Medicare)

Ins. Median: $778 (555% 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 555% of the Medicare baseline (a markup of 455%). 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
Medicare (plans)	$135	96%
Humana	$135	96%
Uuhp	$138 - $2,602	98%
Denver Health	$138	98%
Rocky Mountain Health Plan	$138	98%
Medicaid / KanCare	$138	98%
Health Choice	$138	98%
Employer Direct Healthcare	$170	121%
Motivhealth	$179	128%
Blue Cross Blue Shield	$183 - $2,881	131%
Centura Employee Plan	$186 - $1,680	133%
Cigna	$190 - $3,841	136%
Pehp	$227 - $4,801	162%
Molina	$228 - $2,062	163%
Aetna	$234 - $4,057	167%
UnitedHealthcare	$244 - $2,204	174%
Wise	$276 - $2,545	197%
Multiplan	$313 - $4,369	223%
Deseret Mutual Benefit Administrators	$326 - $2,948	233%
Select Health	$351 - $3,178	250%
Emi Health	$531 - $4,801	379%

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 $401.
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 Holy Cross Hospital - Salt Lake 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.