Skip to main content
States Procedures Methodology Search
Hospital Profile Acute Care Hospital Voluntary non-profit - Private 410 Beds · urban Updated: 2026-03-04

Community Medical Center

99 Rt 37 West, Toms River, NJ 08755 · 131 Priced Procedures · 57% Patient Recommendation

CMS Overall Rating 1 / 5 Stars
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
1.06×vs. Fair Market Price
Position vs. 1.00× Fair Price+6% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +6% above the fair benchmark (1.06×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).79/100 · Corroborated
79/100Self-Pay Cash Beats Insurance 61% of the Time
File Completeness51Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic96Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment66Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing85Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount100Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Benchmark Tier
CMS Star Rating2/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score61/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait182 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

2-Star CMS clinical quality rating paired with 1.06× fair market pricing.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

Community Medical Center maintains elevated commercial insurance contracts (1.06× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 61% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#20 of 52 in NJ · 36th State Percentile#1,551 of 3,385 in U.S. · 45th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.97× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 61% of shoppable procedures (99/100 Cash Honesty)
  • 1-Star CMS clinical rating with 57% patient recommendation (61/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (15.7% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 2.4× markup over Medicare rates
  • Commercial insurance median sits at 1.04× Fair BaseRate (1.9× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 1.32×) jump +27% above the median procedure ratio (Q50 1.04×)
  • Unnegotiated chargemaster list prices average 11.6× Medicare (14¢ true HCRIS cost per $1 gross)
Front-Door ShoppableElective / Imaging
1.9× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.63× Divergence
1.2× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+27% Upper Tail
Q25 0.97× · Q50 1.04× · Q75 1.32×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
1.9× MedicareGood
Outpatient Surgery & ORBack-Door Captive
2.4× MedicareFair
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
2.1× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
2.8× MedicareFair
Inpatient Lab & PathologyBack-Door Captive
3.0× MedicareFair
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.2× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
61% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
1 CMS · 61/100Elevated

Procedure Prices at Community Medical Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 131 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Spinal fusion, single level (inpatient stay)
MS-DRG Code: 451
 $54,890 1.8×
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $35,969 1.9×
Heart stent placement (inpatient stay)
MS-DRG Code: 322
 $33,906 1.9×
Hip or knee replacement (inpatient stay)
MS-DRG Code: 470
 $29,239 1.5×
Total knee replacement
CPT Code: 27447
 $20,329 1.5×
Total hip replacement
CPT Code: 27130
 $20,329 unverified
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $14,304 1.7×
Gallbladder removal (laparoscopic)
CPT Code: 47562
 $7,514 1.2×
Knee arthroscopy with meniscus repair
CPT Code: 29881
 $5,115 unverified
Inguinal hernia repair
CPT Code: 49505
 $4,791 1.3×
Cataract surgery with lens implant
CPT Code: 66984
 $4,288 1.7×
Breast lump removal
CPT Code: 19120
 $4,185 1.1×
Bunion correction surgery
CPT Code: 28296
 $3,941 1.1×
Vaginal delivery (full package)
CPT Code: 59400
 $3,720 1.4×
C-section delivery (full package)
CPT Code: 59510
 $3,720 1.3×
Upper endoscopy with biopsy
CPT Code: 43239
 $2,677 unverified
Colonoscopy (diagnostic)
CPT Code: 45378
 $2,677 unverified
Colonoscopy with biopsy
CPT Code: 45380
 $2,677 unverified
Sleep study (overnight, in lab)
CPT Code: 95810
 $1,809 unverified
Injection procedure for pain management
HCPCS Code: G0260
 $1,770 2.1×
Trauma team activation
HCPCS Code: G0390
 $1,475 1.0×
Hospital observation (per hour)
HCPCS Code: G0378
 $1,141 unverified
Blood transfusion
CPT Code: 36430
 $951 unverified
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $599 1.0×
MRI, brain (with and without contrast)
CPT Code: 70553
 $553 1.1×
Showing top 25 high-impact procedures of 131 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 15.7%

Audit a Bill or Quote at Community Medical Center (Zero PHI Required)

CMS CCN: 310041
CPT 451
Fair BaseRate™ $30,775
Medicare Rate $23,504
Self-Pay Cash $2,426
Insurer Median $54,890
Pre-filled with Community Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $20,643 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $20,643

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (15.7% of gross = $20,643).

Step 2 · Cash vs. Insurance Arbitrage Save $129,310 Paying Cash

Self-Pay Cash Rate ($2,426) Beats Your Bill

Community Medical Center's published 45 CFR § 180 self-pay cash rate is $2,426 (vs. $54,890 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$100,961 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($131,736) is $100,961 above the denoised Fair BaseRate ($30,775) and 5.6× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold
Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier
Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported
26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (15.7% 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.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall2/5 Stars (2/5)
Safety Composite61/100
Would Recommend57%
Rated 9 or 10 (HCAHPS)61%
Median ER Wait182 min
Left ER Before Seen0%
30-Day Mortality vs U.S.same
Unplanned Readmissionsame
Hip/Knee Complication Rate3%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)
Central-Line Bloodstream Infectionbetter
C. diff Hospital-Onset Infectionbetter

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Community Medical Center. Prior administrative notices do not necessarily reflect current compliance status.

  • 2025-03-28·administrative_or_closure

    Met Requirements

    Recorded
  • 2022-02-11·administrative_or_closure

    Closure Notice

    Recorded
  • 2021-09-30·cap_corrective_action

    CAP Request

    Recorded
  • 2021-04-19·warning_notice

    Warning Notice

    Recorded

Source: CMS Hospital Care Compare (2,763 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Community Medical Center.

Price Index: 0.87× regional baseline
Quality: 53/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

WellCare
+73.5%
Median Household Income$86,411U.S. Census ACS
Local Uninsured Share4.2%Regional ACS estimate
200% FPL (1 Person)$31,920Common free-care ceiling
400% FPL (Family of 4)$128,600Common AGB cap ceiling
45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 79/100 · Corroborated CMS CCN 310041

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 310041) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage2026-03-04
Validated Rate Rows3,307 (CMS v3.0.0)
File Integrity DigestVerified · CCN 310041

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.

Submit MRF Update Correction Policy