CMS Price Transparency Data

X-ray, pelvis

Facility: Forks Community Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $250
Cash Discount Price: $365
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Forks Community Hospital is $250. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $365. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.34x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$365

Average discount available for prompt cash payment at this facility.

Insurance Median

$250

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: $365 (342%)

Insurance Median: $250 (234%)

Cash: $365 (342% of Medicare)

Ins. Median: $250 (234% 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 234% of the Medicare baseline (a markup of 134%). 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	$66 - $265	62%
Coordinated Care (Mco) Mcd-All Plans	$71 - $270	66%
UnitedHealthcare	$85 - $615	80%
Community Health Network Mcr-All Other Plans	$86 - $325	81%
Humana	$86 - $325	81%
Tricare	$86 - $325	81%
Triwest-All Plans	$86 - $325	81%
Ambetter / Centene	$99 - $377	93%
Wellcare Med Adv - All Plans	$99 - $377	93%
Regence-All Other Plans	$109 - $416	102%
Community Health Exchange	$124 - $470	116%
Molina Commercial-All Other Plans	$175 - $665	164%
Aetna	$180 - $687	169%
Blue Cross Blue Shield	$180 - $687	169%
Cigna	$190 - $723	178%
First Choice-All Plans	$190 - $723	178%
Medicare (plans)	$318	298%

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 $365.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

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 72170.
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.