CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Forks Community Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $923
Cash Discount Price: $1,644
vs. Medicare Baseline: 8.64x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Forks Community Hospital is $923. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,644. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.64x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$1,644

Average discount available for prompt cash payment at this facility.

Insurance Median

$923

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,644 (1539%)

Insurance Median: $923 (864%)

Cash: $1,644 (1539% of Medicare)

Ins. Median: $923 (864% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 864% of the Medicare baseline (a markup of 764%). 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
Medicare (plans)	$318	298%
Medicaid / KanCare	$319 - $1,168	299%
Coordinated Care (Mco) Mcd-All Plans	$345 - $1,190	323%
UnitedHealthcare	$411 - $2,708	385%
Community Health Network Mcr-All Other Plans	$415 - $1,434	389%
Humana	$415 - $1,434	389%
Tricare	$415 - $1,434	389%
Triwest-All Plans	$415 - $1,434	389%
Ambetter / Centene	$482 - $1,663	451%
Wellcare Med Adv - All Plans	$482 - $1,663	451%
Regence-All Other Plans	$531 - $1,834	497%
Community Health Exchange	$600 - $2,071	562%
Molina Commercial-All Other Plans	$849 - $2,931	795%
Aetna	$877 - $3,027	821%
Blue Cross Blue Shield	$877 - $3,027	821%
Cigna	$923 - $3,186	864%
First Choice-All Plans	$923 - $3,186	864%

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 $1,644.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Forks Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 71250.
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.