CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Community Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $32,908
Cash Discount Price: $2,426
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Community Medical Center is $32,908. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,426. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.57x the Medicare baseline. Located in 99 Rt 37 West, Toms River, NJ.

Cash / Self-Pay

$2,426

Average discount available for prompt cash payment at this facility.

Insurance Median

$32,908

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12,807.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12,807.1 (100%)

Cash / Self-Pay: $2,426 (19%)

Insurance Median: $32,908 (257%)

Cash: $2,426 (19% of Medicare)

Ins. Median: $32,908 (257% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12,807.1 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 257% of the Medicare baseline (a markup of 157%). 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
Wellpoint	$1,885 - $15,805	15%
Blue Cross Blue Shield	$5,624 - $48,229	44%
Aetna	$15,805 - $43,609	123%
Clover Health	$15,805	123%
Fidelis Care	$15,805	123%
Humana	$15,805	123%
UnitedHealthcare	$16,121 - $48,286	126%
Emblem Health	$24,934	195%
Wellcare	$31,452	246%
Cigna	$32,908 - $44,041	257%

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 $2,426.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 322.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Community Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 322.
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.