CMS Price Transparency Data

X-ray, pelvis

Facility: Sanford Worthington Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $193
Cash Discount Price: $281
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sanford Worthington Medical Center is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.81x the Medicare baseline. Located in 1018 Sixth Avenue Po Box 997, Worthington, MN.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $281 (263%)

Insurance Median: $193 (181%)

Cash: $281 (263% of Medicare)

Ins. Median: $193 (181% 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.

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
Blue Cross Blue Shield	$81 - $299	76%
Sanford Health Plan Align	$99	93%
Ucare	$106 - $274	99%
Aetna	$107 - $288	100%
Health Partners	$107 - $249	100%
Medicare (plans)	$107	100%
UnitedHealthcare	$107 - $293	100%
Primewest	$110 - $117	103%
Sanford Health Plan	$136 - $160	127%
Security Health Plan	$193	181%
Medica	$313 - $335	293%
First Choice Health Network	$316	296%
Healthez	$316	296%
Multiplan	$316	296%

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 $281.
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 Worthington 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.