CMS Price Transparency Data

X-ray, pelvis

Facility: Sanford Westbrook Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $417
Cash Discount Price: $399
vs. Medicare Baseline: 3.90x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sanford Westbrook Medical Center is $417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $399. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.90x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.

Cash / Self-Pay

$399

Average discount available for prompt cash payment at this facility.

Insurance Median

$417

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: $399 (374%)

Insurance Median: $417 (390%)

Cash: $399 (374% of Medicare)

Ins. Median: $417 (390% 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 390% of the Medicare baseline (a markup of 290%). 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
Ucare	$112 - $438	105%
Blue Cross Blue Shield	$121 - $462	113%
Sanford Health Plan Align	$214	200%
Wellmark Sd	$229	214%
Aetna	$232 - $434	217%
Health Partners	$232 - $399	217%
Medicare (plans)	$232	217%
UnitedHealthcare	$232 - $417	217%
Primewest	$236 - $252	221%
Security Health Plan	$274	257%
Sanford Health Plan	$394 - $463	369%
Medica	$439 - $472	411%
Cigna	$449	420%
First Choice Health Network	$449	420%
Healthez	$449	420%
Multiplan	$449	420%

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 $399.
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 Westbrook 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.