CMS Price Transparency Data

Hospital observation (per hour)

Facility: St Anthony Community Hospital

Billing Code: G0378 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0378
Insurance Median: $7,135
Cash Discount Price: Unavailable
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hospital observation (per hour) at St Anthony Community Hospital is $7,135. 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 N/A, this hospital’s rate is N/A the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,135

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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
Oxford Commercial	$2,777	N/A
Emblem Select Care (Exchange)	$4,453	N/A
Oxford Exchange	$4,878	N/A
UnitedHealthcare	$4,878 - $5,739	N/A
Emblem Ghi/Hip Hmo/Epo/Pos	$5,239	N/A
Emblem Ghi/Hip PPO	$5,239	N/A
Magnacare Preferred	$6,213	N/A
Mvp Exchange	$6,783	N/A
Cigna	$7,135	N/A
Aetna	$7,811 - $8,679	N/A
Mvp Hmo/Ppo	$7,980	N/A
Blue Cross Blue Shield	$8,096 - $9,994	N/A
Self-Pay	$11,226	N/A
Tricare	$50,000	N/A

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: G0378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Anthony Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0378.
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.