CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Forks Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $196
Cash Discount Price: $320
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Forks Community Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $320. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.45x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$320

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $320 (236%)

Insurance Median: $196 (145%)

Cash: $320 (236% of Medicare)

Ins. Median: $196 (145% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
UnitedHealthcare	$37 - $319	27%
Coordinated Care (Mco) Mcd-All Plans	$58 - $232	43%
Medicaid / KanCare	$58 - $228	43%
Cigna	$85 - $621	63%
Molina Commercial-All Other Plans	$85 - $571	63%
Triwest-All Plans	$85 - $279	63%
Va-Ihs - All Plans	$85	63%
Tricare	$86 - $279	63%
Ambetter / Centene	$99 - $324	73%
Aetna	$101 - $590	74%
First Choice-All Plans	$106 - $621	78%
Regence-All Other Plans	$106 - $358	78%
Blue Cross Blue Shield	$109 - $590	80%
Community Health Exchange	$115 - $404	85%
Community Health Network Mcr-All Other Plans	$169 - $279	125%
Humana	$169 - $279	125%
Wellcare Med Adv - All Plans	$196 - $324	145%
Medicare (plans)	$318	235%

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 $320.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.