St Anthony Community Hospital
15 Maple Avenue -19, Warwick, NY 10990 · 107 Priced Procedures · 71% Patient Recommendation
Typical commercial prices here are +141% above the fair benchmark (2.41×) even after accounting for local nurse/doctor wages and patient complexity.
3-Star CMS clinical quality rating paired with 2.41× fair market pricing.
Wide Procedure Spread · Upper-Quartile Skew Pricer
St Anthony Community Hospital prices routine shoppable procedures at 2.9× Medicare (median 2.37× Fair BaseRate) while upper-quartile commercial rates jump +22% to 2.89× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 1.68× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 10% of shoppable procedures (25/100 Cash Honesty)
- 4-Star CMS clinical rating with 71% patient recommendation (64/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (34.0% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (2.41× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Commercial insurance median sits at 2.37× Fair BaseRate (2.9× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 2.89×) jump +22% above the median procedure ratio (Q50 2.37×)
- Consolidated metro market (HHI 2,645) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at St Anthony Community Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 107 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $56,074 | unverified |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $54,429 | unverified |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $50,893 | unverified |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $22,505 | 2.7× |
| Total hip replacement CPT Code: 27130 | $14,658 | 1.1× |
| Total knee replacement CPT Code: 27447 | $14,658 | 1.1× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $11,880 | 1.9× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $8,719 | 2.6× |
| Inguinal hernia repair CPT Code: 49505 | $8,719 | 2.4× |
| Bunion correction surgery CPT Code: 28296 | $7,858 | 2.3× |
| Breast lump removal CPT Code: 19120 | $7,230 | 1.9× |
| Cataract surgery with lens implant CPT Code: 66984 | $6,146 | 2.4× |
| Colonoscopy with biopsy CPT Code: 45380 | $4,905 | 3.9× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $4,188 | 4.3× |
| Upper endoscopy with biopsy CPT Code: 43239 | $4,188 | 4.2× |
| Blood transfusion CPT Code: 36430 | $2,676 | 5.4× |
| Trauma team activation HCPCS Code: G0390 | $2,438 | 1.7× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $2,157 | 2.1× |
| MRI, knee or other leg joint CPT Code: 73721 | $2,171 | unverified |
| Ultrasound, thyroid and neck CPT Code: 76536 | $2,089 | unverified |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $2,089 | unverified |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $1,430 | 3.2× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $1,430 | 2.8× |
| Speech therapy (language evaluation) CPT Code: 92507 | $1,060 | 12.3× |
| MRI, lower back (no contrast) CPT Code: 72148 | $978 | 2.9× |
Audit a Bill or Quote at St Anthony Community Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $45,757
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (34.0% of gross = $45,757).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask St Anthony Community Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)
Your bill ($134,578) is $115,491 above the denoised Fair BaseRate ($19,087) and 9.5× the $14,117 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (34.0% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (324 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for St Anthony Community Hospital.
Notable Payer Contract Outliers (SVD Matrix Anomalies)
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.