CMS Price Transparency Data

Hepatitis B immune globulin

Facility: Mountain View Hospital

Billing Code: 90371 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90371
Insurance Median: $241
Cash Discount Price: $1,952
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Hepatitis B immune globulin at Mountain View Hospital is $241. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,952. Compared to the federal Medicare reimbursement reference rate of $140.21, this hospital’s rate is 1.72x the Medicare baseline. Located in 1000 East 100 North, Payson, UT.

Cash / Self-Pay

$1,952

Average discount available for prompt cash payment at this facility.

Insurance Median

$241

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: $1,952 (1392%)

Insurance Median: $241 (172%)

Cash: $1,952 (1392% of Medicare)

Ins. Median: $241 (172% 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
Regence Triwest	$141	101%
Cigna	$156 - $202	111%
Regence	$216 - $351	154%

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 $1,952.
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 Mountain View 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.