CMS Price Transparency Data

X-ray, pelvis

Facility: Sanford Canby Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $385
Cash Discount Price: $377
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sanford Canby Medical Center is $385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $377. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.60x the Medicare baseline. Located in 112 St Olaf Avenue South, Canby, MN.

Cash / Self-Pay

$377

Average discount available for prompt cash payment at this facility.

Insurance Median

$385

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: $377 (353%)

Insurance Median: $385 (360%)

Cash: $377 (353% of Medicare)

Ins. Median: $385 (360% 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 360% of the Medicare baseline (a markup of 260%). 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 - $414	105%
Blue Cross Blue Shield	$114 - $385	107%
Sanford Health Plan Align	$215	201%
Aetna	$233 - $409	218%
Health Partners	$233 - $377	218%
Medicare (plans)	$233	218%
UnitedHealthcare	$233 - $393	218%
Primewest	$237 - $259	222%
Security Health Plan	$259	242%
Sanford Health Plan	$372 - $437	348%
Medica	$414 - $446	388%
Cigna	$424	397%
First Choice Health Network	$424	397%
Healthez	$424	397%
Multiplan	$424	397%

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 $377.
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 Canby 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.