CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Community Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $33,102
Cash Discount Price: $2,426
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Community Medical Center is $33,102. 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 $14,116.91, this hospital’s rate is 2.34x 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

$33,102

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)

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

Insurance Median: $33,102 (234%)

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

Ins. Median: $33,102 (234% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,116.91 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 234% of the Medicare baseline (a markup of 134%). 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 - $17,141	13%
Blue Cross Blue Shield	$5,014 - $43,968	36%
Qualcare Inc	$5,673 - $5,944	40%
Aetna	$17,141 - $47,294	121%
Clover Health	$17,141	121%
Fidelis Care	$17,141	121%
Humana	$17,141	121%
UnitedHealthcare	$17,484 - $52,366	124%
Emblem Health	$27,042	192%
Wellcare	$34,110	242%
Cigna	$35,689 - $47,763	253%
Amerihealth	$41,544 - $51,922	294%

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: 871.

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 871.
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.