CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Forks Community Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $242
Cash Discount Price: $366
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Forks Community Hospital is $242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $366. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.72x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$366

Average discount available for prompt cash payment at this facility.

Insurance Median

$242

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $366 (412%)

Insurance Median: $242 (272%)

Cash: $366 (412% of Medicare)

Ins. Median: $242 (272% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 272% of the Medicare baseline (a markup of 172%). 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
Medicaid / KanCare	$75 - $256	84%
Coordinated Care (Mco) Mcd-All Plans	$81 - $261	91%
UnitedHealthcare	$97 - $594	109%
Community Health Network Mcr-All Other Plans	$98 - $315	110%
Humana	$98 - $315	110%
Tricare	$98 - $315	110%
Triwest-All Plans	$98 - $315	110%
Ambetter / Centene	$113 - $365	127%
Wellcare Med Adv - All Plans	$113 - $365	127%
Regence-All Other Plans	$125 - $402	141%
Community Health Exchange	$141 - $454	159%
Molina Commercial-All Other Plans	$200 - $643	225%
Aetna	$206 - $664	232%
Blue Cross Blue Shield	$206 - $664	232%
Cigna	$217 - $699	244%
First Choice-All Plans	$217 - $699	244%
Medicare (plans)	$318	358%

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 $366.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72040.

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 72040.
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.