CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Sanford Sheldon Medical Center

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $300
Cash Discount Price: $372
vs. Medicare Baseline: 3.37x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Sanford Sheldon Medical Center is $300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $372. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.37x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$372

Average discount available for prompt cash payment at this facility.

Insurance Median

$300

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: $372 (418%)

Insurance Median: $300 (337%)

Cash: $372 (418% of Medicare)

Ins. Median: $300 (337% 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 337% of the Medicare baseline (a markup of 237%). 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	$133	150%
Ucare	$142 - $409	160%
Aetna	$144 - $404	162%
Blue Cross Blue Shield	$144	162%
Health Partners	$144 - $349	162%
Medicare (plans)	$144	162%
UnitedHealthcare	$144 - $388	162%
Primewest	$146	164%
Wellmark	$232 - $242	261%
Sanford Health Plan	$249 - $293	280%
Security Health Plan	$256	288%
Medica	$384 - $410	432%
First Choice Health Network	$418	470%
Healthez	$418	470%
Multiplan	$418	470%

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 $372.
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 Sanford Sheldon Medical Center 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.