CMS Price Transparency Data

X-ray, pelvis

Facility: Sanford Sheldon Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $264
Cash Discount Price: $327
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sanford Sheldon Medical Center is $264. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $327. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.47x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$327

Average discount available for prompt cash payment at this facility.

Insurance Median

$264

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: $327 (306%)

Insurance Median: $264 (247%)

Cash: $327 (306% of Medicare)

Ins. Median: $264 (247% 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 247% of the Medicare baseline (a markup of 147%). 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	$117	110%
Ucare	$125 - $359	117%
Aetna	$126 - $355	118%
Blue Cross Blue Shield	$126	118%
Health Partners	$126 - $307	118%
Medicare (plans)	$126	118%
UnitedHealthcare	$126 - $342	118%
Primewest	$129	121%
Wellmark	$204 - $213	191%
Sanford Health Plan	$219 - $258	205%
Security Health Plan	$225	211%
Medica	$337 - $361	316%
First Choice Health Network	$368	345%
Healthez	$368	345%
Multiplan	$368	345%

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 $327.
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 Sanford Sheldon Medical Center 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.