CMS Price Transparency Data

Trauma team activation

Facility: Good Samaritan Hospital of Suffern

Billing Code: G0390 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0390
Insurance Median: $2,438
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Trauma team activation at Good Samaritan Hospital of Suffern is $2,438. 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 $1,361.78, this hospital’s rate is 1.79x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,438

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,361.78

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,361.78 (100%)

Insurance Median: $2,438 (179%)

Ins. Median: $2,438 (179% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,361.78 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
Beacon Commercial	$193	14%
Oxford Exchange	$1,530	112%
UnitedHealthcare	$1,530 - $1,800	112%
Oxford Commercial	$1,718	126%
Magnacare Preferred	$2,434	179%
Mvp Exchange	$2,442	179%
Aetna	$2,676 - $2,973	197%
Cdphp	$2,687	197%
Mvp Hmo/Ppo	$2,873	211%
Tricare	$50,000	3672%

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: G0390.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Hospital of Suffern is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0390.
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.