CMS Price Transparency Data

X-ray, lower back

Facility: Sanford Sheldon Medical Center

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $454
Cash Discount Price: $562
vs. Medicare Baseline: 4.25x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Sanford Sheldon Medical Center is $454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $562. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.25x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$562

Average discount available for prompt cash payment at this facility.

Insurance Median

$454

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: $562 (526%)

Insurance Median: $454 (425%)

Cash: $562 (526% of Medicare)

Ins. Median: $454 (425% 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 425% of the Medicare baseline (a markup of 325%). 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
Sanford Health Plan Align	$200	187%
Ucare	$215 - $618	201%
Aetna	$217 - $611	203%
Blue Cross Blue Shield	$217	203%
Health Partners	$217 - $527	203%
Medicare (plans)	$217	203%
UnitedHealthcare	$217 - $587	203%
Primewest	$221	207%
Wellmark	$352 - $366	330%
Sanford Health Plan	$377 - $443	353%
Security Health Plan	$387	362%
Medica	$580 - $620	543%
First Choice Health Network	$633	593%
Healthez	$633	593%
Multiplan	$633	593%

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 $562.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Sheldon Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.