CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Community Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $26,200
Cash Discount Price: $2,426
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Community Medical Center is $26,200. 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 $14,044.15, this hospital’s rate is 1.87x 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

$26,200

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $2,426 (17%)

Insurance Median: $26,200 (187%)

Cash: $2,426 (17% of Medicare)

Ins. Median: $26,200 (187% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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
Wellpoint	$1,885 - $16,472	13%
Qualcare Inc	$5,673 - $5,944	40%
Blue Cross Blue Shield	$6,471 - $40,593	46%
Aetna	$16,472 - $38,166	117%
Clover Health	$16,472	117%
Fidelis Care	$16,472	117%
Humana	$16,472	117%
UnitedHealthcare	$16,801 - $38,000	120%
Cigna	$20,787 - $27,819	148%
Emblem Health	$25,986	185%
Amerihealth	$29,239 - $30,965	208%
Wellcare	$32,778	233%

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: 470.

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 470.
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.