CMS Price Transparency Data

Total hip replacement

Facility: Community Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $20,329
Cash Discount Price: $3,786
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Community Medical Center is $20,329. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,786. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.55x the Medicare baseline. Located in 99 Rt 37 West, Toms River, NJ.

Cash / Self-Pay

$3,786

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,329

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $3,786 (29%)

Insurance Median: $20,329 (155%)

Cash: $3,786 (29% of Medicare)

Ins. Median: $20,329 (155% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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
Qualcare Inc	$2,699	21%
Wellpoint	$3,266 - $14,062	25%
Blue Cross Blue Shield	$7,245 - $14,062	55%
Aetna	$14,062 - $26,240	107%
Clover Health	$14,062	107%
Fidelis Care	$14,062	107%
Humana	$14,062	107%
UnitedHealthcare	$14,343 - $26,500	109%
Cigna	$15,999 - $21,412	122%
Amerihealth	$21,284 - $23,943	162%
Emblem Health	$24,608	188%
Wellcare	$27,983	213%

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 $3,786.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

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 CPT code 27130.
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.